Richard Titmuss: A Commitment to Welfare 9781447341062

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RICHARD

TITMUSS A COMMITMENT TO WELFARE JOHN STEWART

RICHARD TITMUSS A Commitment to Welfare JOHN STEWART

First published in Great Britain in 2020 by    Policy Press University of Bristol 1-​9 Old Park Hill Bristol BS2 8BB UK t: +44 (0)117 954 5940 pp-​[email protected] www.policypress.co.uk    © Policy Press 2020      British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library      ISBN 978-​1-​4473-​4105-​5 hardcover ISBN 978-​1-​4473-​4106-​2  ePub ISBN 978-​1-​4473-​4107-​9  ePdf      The right of John Stewart to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.      All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Policy Press.      The statements and opinions contained within this publication are solely those of the author and not of the University of Bristol or Policy Press. The University of Bristol and Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication.      Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality.      Cover design by Robin Hawes Front cover image: Reproduced courtesy of Professor Ann Oakley Printed and bound in Great Britain by CPI Group (UK) Ltd, Croydon, CR0 4YY Policy Press uses environmentally responsible print partners

Contents Acronyms Acknowledgements

x xi

1 Introduction Titmuss in the twentieth century The ‘Titmuss paradigm’ Understanding Titmuss: David Reisman Titmuss the person This volume

1 1 4 7 8 11

Part 1 Early life and career to the end of 1941 2

3

4

5

‘As the son of a farmer…’: origins, early employment, and personal life Introduction Birth, childhood, and youth Employment Marriage and private life Conclusion

19

Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March Introduction The Liberal Party and the Fleet Street Parliament International affairs: ‘Crime and Tragedy’ Liberal Summer School Forward March Titmuss’s liberalism Conclusion

33

The Eugenics Society, Poverty and Population, and ‘Manpower and Health’ Introduction The Eugenics Society Poverty and Population Government statistics and population health in peace and war Conclusion

51

The Titmuss gospel and progressive opinion Introduction

69 69

iii

19 21 23 25 30

33 34 35 40 42 45 47

51 51 53 57 65

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Getting the message out R.H. Tawney and The Acquisitive Society Saving the poor and feeding the masses Conclusion

70 74 77 81

Part 2 From Problems of Social Policy to the London School of Economics 6

Problems of Social Policy: researching and firewatching Introduction The trials of authorship The history of the Home Front Lady Allen and Lady Reading The volume’s reception Rethinking Problems of Social Policy Firewatching Conclusion

85 85 86 91 95 99 101 104 105

7

Titmuss and the Eugenics Society in war Introduction Committee man, editor, and contributor Birth, Poverty and Wealth The Population Investigation Committee Conclusion

109 109 109 115 118 122

8

Titmuss and the media in the 1940s: a growing reputation Introduction Writing and lecturing On the air Conclusion

125 125 125 131 135

9

Population and family: Parents Revolt and the beginnings of social medicine Introduction Parents Revolt Titmuss and Churchill Social medicine The Social Medicine Research Unit Conclusion

137

iv

137 137 140 143 147 151

Contents

10 The London School of Economics and ‘Social Administration in a Changing Society’ Introduction Coming to the LSE Social Administration in a changing society Working in the department Conclusion

155 155 156 160 166 168

Part 3 First decade at the LSE 11 Setting out his stall Introduction ‘The Position of Women’ North of the border ‘The Social Division of Welfare’ Addressing social workers Discussion Conclusion

173 173 173 176 178 182 184 186

12 The Guillebaud Committee and the early years of the National Health Service Introduction Thinking about the NHS The Guillebaud Committee After Guillebaud: prescriptions After Guillebaud: Members One of Another Parallels in education Conclusion

189

13 Pensions and old age Introduction The employment of older people Titmuss and Beveridge ‘The Age of Pensions’ The Labour Party and pensions National superannuation Welfare professor Conclusion

205 205 206 208 209 213 215 221 223

14 ‘We have our differences and do not always see eye to eye’: social work and social work training Introduction

227

v

189 190 193 197 199 201 202

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Thinking about social work Titmuss, Younghusband, and social work training Not what should be done, but who should do it Conclusion 15 Essays on ‘The Welfare State’ and The Irresponsible Society Introduction Essays on ‘The Welfare State’ The Irresponsible Society: the context The Irresponsible Society: the speech, the pamphlet, and the reaction The Irresponsible Society: the aftermath Conclusion

228 230 240 246 251 251 251 255 258 266 268

Part 4 Power and influence: Titmuss, 1960 to 1973 16 ‘The apostle of equality’: Titmuss and R.H. Tawney Introduction The birthday party Celebrating Tawney Occupational pensions revisited: more inequality Conclusion

273 273 274 275 282 285

17 Mental health, community care, and medical education Introduction Mental health and community care The Royal Commission on Medical Education (the Todd Commission) Titmuss’s contribution Conclusion

289 289 289 294

18 Mauritius, Tanganyika (Tanzania), and Israel Introduction Mauritius Tanganyika Israel: first contact Keeping in touch: the Jerusalem seminar and after Conclusion

307 307 308 311 316 320 326

19 Scottish social work and the Seebohm Committee Introduction Scottish social work

331 331 332

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298 303

Contents

The Seebohm Committee Social work and social workers Conclusion

335 343 345

20 Commitment to Welfare and the Finer Committee on One-​Parent Families Introduction Commitment to Welfare The Finer Committee on One-​Parent Families Income maintenance Contributing to the Committee International comparisons Titmuss and lone mothers Conclusion

349

21 Titmuss and North America: early encounters and first visit Introduction Making contacts and making comparisons Invitations Yale and the National Health Service Columbia and social work Conclusion

369 369 369 372 375 380 383

22 Helping American scholars on British topics Introduction Social welfare: Heclo and Gilbert Health: Eckstein, Lindsey, and Mencher Researching Tawney: Terrill A transatlantic research project Conclusion

387 387 387 390 396 397 400

23 Titmuss and President Johnson’s ‘War on Poverty’ Introduction Social welfare in 1960s America Back in the USA Addressing the issues Talking to The Nation Chicago, 1966 Conclusion

403 403 403 405 408 411 415 419

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349 349 354 356 359 362 363 365

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24 ‘One of the greatest human beings of our time’: Titmuss’s influence on North American thinking on social welfare Introduction ‘I hope you know the extent of your influence here’ Commitment to Welfare and North America Americans remember Conclusion

423 423 424 428 431 436

Part 5 Troubles? 25 The Labour government, social policy, and the Supplementary Benefits Commission Introduction The poverty lobby Appointment to the Supplementary Benefits Commission ‘New Guardians of the Poor’ Defending the SBC: staff Defending the SBC: critics Titmuss and Townsend Defending the SBC: universal or selective? Conclusion

441

26 A public figure in troubled times: Vietnam, race relations, and the Common Market Introduction Vietnam Race relations The Common Market Conclusion

467

27 Healthcare, the market, and the Institute of Economic Affairs:  the making of The Gift Relationship Introduction Early skirmishes More grief Building his case The IEA again The Gift Relationship Reading The Gift Relationship Conclusion

483

viii

441 441 443 446 448 451 458 460 463

467 468 470 477 479

483 484 488 489 494 497 498 500

Contents

28 ‘It really is hell’: disruption at the LSE Introduction Titmuss and students A new director More problems and bad publicity Titmuss’s take on ‘The Troubles’ Interpreting ‘The Troubles’ Titmuss, Townsend, and ‘The Troubles’ Conclusion

505 505 505 507 509 511 514 516 519

29 ‘A new prophet had appeared in our midst’: final illness, death, and memorial service Introduction Cancer Soldiering on Remembering Richard Titmuss Memorial service Conclusion

523 523 524 527 530 531 536

Part 6 Conclusion 30 A commitment to welfare: the life and work of Richard Titmuss Introduction Life and career A ‘philosophy of welfare’? Titmuss in the twenty-​first century ‘A way of looking at the world’

541 541 542 546 553 555

Publications by Richard Titmuss cited in this volume Frequently cited secondary sources Archival sources Index

559 565 566 567

ix

Acronyms AMA BLPES BMJ BPP BSA CBE CPAG DHSS GP IEA ISSA LCC LSE LSHTM MOH MP MRC NAB NAMH NEC NHS PEP PIC RAMC SBC SMA TUC WEA WVS

American Medical Association British Library of Political and Economic Science British Medical Journal British Parliamentary Papers British Sociological Association Commander of the British Empire Child Poverty Action Group Department of Health and Social Security General Practitioner Institute of Economic Affairs International Social Security Association London County Council London School of Economics and Political Science London School of Hygiene and Tropical Medicine Medical Officer of Health Member of Parliament Medical Research Council National Assistance Board National Association for Mental Health Labour Party National Executive Committee National Health Service Political and Economic Planning Population Investigation Committee Royal Army Medical Corps Supplementary Benefits Commission Socialist Medical Association Trades Union Congress Workers’ Educational Association Women’s Voluntary Services

x

Acknowledgements This book originated at a lunch at the London School of Economics in spring 2015, one of the (very) unexpected outcomes of which was that I  was commissioned by LSE Health (now the Department of Health Policy), supported by the Brian Abel-​Smith Foundation Fund, to write this biography, part of the series ‘LSE Pioneers of Social Policy’. The driving force behind this was Jane Lewis, then Professor of Social Policy at the School. The late Walter Holland became my principal LSE contact, and gave me much calm advice. Early on in my research I contacted Sally Sheard, biographer of Brian Abel-​Smith. Sally gave me a number of invaluable pointers as to how to approach a project of this type as well as providing me with some of the key primary materials used here. Other material came from Nick Timmins, for which I am grateful. Titmuss’s daughter, Ann Oakley, kindly allowed me access to papers of her father which she still holds, and to her family photograph album. She was an endless supply of information, and a congenial companion over post-​research glasses of wine. In a more formal sense, I also interviewed Ann about her memories of her father. Others who knew Titmuss and kindly gave me their recollections, either in person or by email, were Alan Deacon, the late David Donnison, Frank Field, Howard Glennerster, Jose Harris, the late Walter Holland, Maggie May, David Piachaud, Bob Pinker, Adrian Sinfield, and Pat Thane. Sonia Exley of the Department of Social Policy at the LSE allowed me early access to the interviews she had undertaken with former department members. Lise Butler, City University, generously sent me a copy of her DPhil thesis on Michael Young. Papers given at the University of Warwick, the University of Oxford, the London School of Hygiene and Tropical Medicine, the University of Durham, the Royal Dublin Society, the Institute of Historical Research, the University of East Anglia, the London School of Economics, the University of Edinburgh, the University of Strathclyde, and the University of Birmingham gave me the opportunity to try out ideas, and I am grateful for the feedback I received. A work of this sort would not be possible without the assistance of library and archive staff and here I should mention in particular colleagues at the Archives Reading Room, British Library of Political and Economic Science; the Modern Records Centre, University of Warwick;Archives and Special Collections, Oxford Brookes University; and Labour Party Archives, Salford. At the LSE/​BLPES Sue Donnelly and Anna Towson were helpful from the outset, important not least

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given the amount of time I spent there. The administrative staff at the Department of Health Policy were always supportive and reliable. Our family friend, Sue Sidgwick, provided me with a base in London from which to make my forays into papers held at the BLPES. Since starting this project I have had numerous conversations with colleagues and friends about Richard Titmuss, and would like to acknowledge the support, encouragement, and insights of Virginia Berridge, Linda Bryder, Martin Gorsky, John Hall, Harry Hendrick, Jane Lewis, John Macnicol, Robert Page, Margaret Pelling, Sally Sheard, Nick Timmins, and John Welshman. Draft chapters were read by Linda Bryder, George Campbell Gosling, Janet Greenlees, John Hall, Harry Hendrick, Eddy Higgs, Vicky Long, Ann Oakley, Glen O’Hara, Margaret Pelling, Chris Renwick, Sally Sheard, Sue Stewart, and John Welshman. I am grateful to each of them for their comments. Ann Oakley also helpfully corrected a number of factual errors in the penultimate draft. This book is dedicated to Ada Mary Susan Stewart, born July 2019, and to her parents, Caitlin and Neil, uncle Jim, and grandmother Sue.

xii

Also available in the LSE Pioneers in Social Policy series The Passionate Economist

How Brian Abel-Smith Shaped Global Health and Social Welfare By Sally Sheard “Sheard provides powerful evidence as to why Brian Abel-Smith, through his incisive and influential contributions to the development of health and social welfare policy both in Britain and further afield, should be regarded as one of the titans of post-1945 social administration.” Journal of Social Policy HB £45.00 ISBN 9781447314844 576 pages November 2013 For more information about the book and to order a copy visit policy.bristoluniversitypress.co.uk/lse-pioneers-in-social-policy

1 Introduction Titmuss in the twentieth century Richard Morris Titmuss was born in October 1907, and died in April 1973. His life thus embraced a period central to British social welfare history. At the time of his birth the reforming Liberal governments of 1906–​14 were enacting measures such as old age pensions. In his inaugural lecture at the London School of Economics (LSE) in 1950, Titmuss acknowledged ‘the great surge forward in legislation for collective help’ in the decade preceding the First World War.1 That conflict was followed by the uncertainties of the inter-​war era, the consequences of which informed Titmuss’s early work, and political activities. By the late 1930s, now married to social worker Kathleen (Kay) Caston Miller, he had produced his first published volume, Poverty and Population, which opened with the striking statement that there could be ‘no subject of more fundamental importance to any nation than the physical and mental well-​being of its people’.2 Titmuss was, at this point, an active member of the Liberal Party. His research, again mostly on population and population health, continued into the Second World War. But his most significant wartime activity came with his engagement to contribute to the series of official histories of the war on the Home Front.Titmuss’s volume, Problems of Social Policy, was published in 1950, contributed to a life-​changing advance in his career, and continues to influence how we perceive wartime Britain.The war also engendered much discussion about post-​war social reconstruction, of which Titmuss was a committed advocate, leading him to shift his political allegiance to the Labour Party. The wartime coalition, and the Labour governments of 1945–​51, duly instituted measures which came to be collectively known as the ‘welfare state’. Perhaps most famously, the National Health Service

1

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(NHS) was created. Titmuss later described this as ‘one of the most unsordid and civilised actions in the history of health and welfare policy’.3 Nonetheless, he viewed the ‘welfare state’ as unfinished business.The expression itself, moreover, had acquired unwelcome, and inaccurate, connotations. Particularly for the political right, it implied state-​provided services aimed primarily at the poor, and which were an economic burden on the rest of society.Titmuss usually put the phrase in inverted commas, a practice followed here, and saw his role as promoting a more positive, more socially just, version of state-​sponsored welfare. For Titmuss, social policy required a moral purpose, aimed at promoting social solidarity and cohesion, and at reducing inequalities. The ‘welfare state’ was central to the post-​war consensus which lasted until the early 1970s. This purportedly (it is a matter of debate) saw broad political agreement based on Keynesian economic management, and ‘welfare state’ consolidation and expansion. Consequently, the period has been described as that of the ‘classic welfare state’. The Conservative Party dominated politically, being in office from 1951 to 1964, and again from 1970 to 1974. Partly as a result of the success of Problems of Social Policy, Titmuss was appointed as the first Professor of Social Administration at the LSE, where he remained for the rest of his life. As is often remarked, this appointment was unusual, not least in Titmuss’s lack of formal academic qualifications. His department had been, prior to his arrival, primarily concerned with training social workers.Titmuss set about developing, indeed creating, what would ultimately be called the field of Social Policy, at first almost single-​handedly, and became its pre-​eminent figure. Titmuss moved Social Administration away from vocational training, or simply describing the social services.  Although he did not neglect such matters, he also sought to promote original research, and to influence policy. This partly explains the eventual abandonment, near the end of Titmuss’s life, of the term ‘Social Administration’, and its replacement by ‘Social Policy’ (although the passing of ‘Social Administration’ was lamented by some).4 The field’s expansion, led by the LSE, further involved the recruitment of individuals who themselves became among its leading figures, for example Brian Abel-​Smith and Peter Townsend. The Titmuss group became known, collectively, as the ‘Titmice’. This was not a very good joke, could be used either affectionately or satirically, and the expression will not be employed again (confusingly,Titmuss used it to refer to himself and Kay),5 but it does convey the tight-​knit nature of the group around Titmuss, and his leadership role within it. The eminent sociologist, T.H. Marshall, instrumental in Titmuss’s appointment, acknowledged in his own work on Social Policy his

2

Introduction

intellectual debt to his colleagues at the LSE, ‘most of whom are now members of the remarkable team headed by Professor Titmuss’.6 In a lecture in 1972, the Cambridge economist, and later Nobel Prize winner, James Meade, expressed his gratitude for the comments of ‘that remarkable triad of professors  –​Titmuss, Townsend and Abel-​ Smith  –​who were responsible for putting (poverty) back into the political arena’.7 More critically, in the mid-​1960s Geoffrey Howe, a rising star in the Conservative Party who frequently crossed swords with Titmuss, identified one recent manifestation of the Fabian Society as ‘Prof Titmuss and his insidious circus of disciples at the London School of Economics’. This piece was entitled ‘The Fabian Threat to Freedom’.8 For Howe, and those of like mind, state welfare created dependency, while diminishing individual responsibility and freedom of choice. Nor were critics confined to the political right. The 1960s also saw the rise of the New Left. Primarily an intellectual movement based around re-​readings of Marx, the New Left gained some traction in higher education, notably through its journal New Left Review. Ralph Miliband, an LSE colleague of Titmuss’s (although distinctly uncollegial when it came to the Department of Social Administration), wrote in the Review’s first edition of the ‘sickness of Labourism’. The Labour Party had, admittedly, made some moderate gains in the post-​war era, but these were the exception, not the rule. What was needed was an actively socialist programme, and Miliband was sceptical about this being formulated by Labour as presently constituted. By such accounts, welfare propped up, rather than challenged, capitalism.9 Titmuss and his circle were at various points highly influential on Labour’s welfare thinking, part of the reason behind Howe’s attack, and Miliband’s disdain. Arthur Seldon of the free-​market think tank the Institute of Economic Affairs (IEA), another long-​time Titmuss adversary, remarked in the mid-​1990s that while, generally speaking, ‘Ideas Are Not Enough’, nonetheless in the 1960s ‘sociologists’ played a central role in Labour Party policy. He cited the activities of, among others, Abel-​Smith and Townsend –​however, no doubt deliberately, he declined to mention Titmuss himself.10 More sympathetically, David Donnison, a Titmuss recruit to the LSE in 1956, noted Titmuss’s contribution, on Labour’s behalf, to areas such as social security reform.11 The return of a Labour government in 1964 raised expectations for positive welfare measures. But caution is required here. It has been argued that the Titmuss group was highly influential in shaping Labour’s pensions policy in the mid-​1950s, but much less so in the late 1960s, the group’s ongoing close relationship to leading Labour politicians notwithstanding.12 It was perhaps such limitations which made another

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former colleague, David Piachaud, remark, in an otherwise sympathetic obituary, that in ‘terms of direct political influence Titmuss was not outstanding’.13 Titmuss did not place the various dimensions of his work in separate compartments, and others clearly saw him in this holistic light. In 1960, for instance, he was approached by Kingsley Martin, editor of the left-​ wing journal New Statesman. Martin told him that Richard Crossman, prominent Labour politician and longstanding Titmuss supporter, had suggested that he ‘might be induced to spend a few evenings trying to work out some unofficial policy on such subjects as education, science and the state and nuclear development’. Other members of the proposed small group were to be the scientist, novelist, and senior civil servant C.P. Snow, and the Nobel Prize-​winning physicist Patrick Blackett. Martin hoped that Titmuss would join them, commenting that there was a ‘complete absence of serious thinking on the Left’.14 It is unclear whether Titmuss did meet up with the others, but that he was invited to do so is a tribute to the intellectual esteem in which he was held. We can see here, too, the Labour Party seeking to embrace modernisation, a move which culminated in Harold Wilson’s famous praise, the ‘white heat’ of the new ‘scientific revolution’, a phenomenon with which Snow and Blackett were closely associated.15 But it was as an authority on welfare that Titmuss was most well-​known, with Crossman describing him, in 1971, as ‘one of the great creative minds of our social services’.16 If Titmuss’s life began at the time of the Edwardian Liberal welfare reforms, and embraced the coming of the ‘welfare state’, what was the situation as it came to an end? By the early 1970s the post-​war consensus was under threat. While the ‘welfare state’ had always had its critics, it now faced serious challenges.The IEA’s free-​market ideas, to take but one, were gaining ground, and were avidly consumed by Margaret Thatcher, soon to be Conservative Party leader. The era of neo-​liberalism was about to commence, something which would have profoundly disturbed Titmuss. On one level, relating an individual life to the events and processes which that life witnessed is a conceit. But using Titmuss’s lifespan as a sort of framing device is, nonetheless, revealing. It is particularly so with regard to the span of his academic career, coinciding as it did with the era of the ‘classic welfare state’.

The ‘Titmuss paradigm’ Titmuss’s contribution to social analysis took various forms. In the case of publications, these ranged from scholarly monographs to short

4

Introduction

newspaper articles.There were a lot of them. Matthew Hough has identified nearly 200 pieces, conceivably an underestimate.17 The present volume engages with just under 100 published items, not including book reviews or letters to the press, both of which Titmuss also used to bring his ideas to public attention. He was, too, a frequent contributor to radio programmes from the 1940s onwards, and later appeared several times on television. Titmuss was, to put it mildly, keen to get his ideas across. It is important to stress this point. Titmuss was not the sort of social scientist who, for example, conducted interviews or dealt with the ‘clients’ of the ‘welfare state’ face to face. Rather, his research strength lay in the analysis of large volumes of empirical data. The resulting analyses were then to be disseminated as widely as possible, and used to inform policy formation. Such was Titmuss’s dominance of his field up to his death that his ideas are seen as constituting a ‘paradigm’. To give some flavour of this, we take an article from 1964, revealingly entitled ‘The Limits of the Welfare State’. For Titmuss, ‘neo-​classical economics and the private market’ could not deal with social costs deriving from, for instance, the impact of automation on the labour market or, and here he took a distressing contemporary example, the effect of the drug thalidomide.This had been prescribed, without proper testing, to pregnant women in 1963–​64, resulting in deformities to their children. It was a central claim of Titmuss’s that the free market (or economic growth itself, for that matter) could not deal adequately with social dislocation, social inequality, and social injustice. As he often did,Titmuss next gave an historical account of how welfare had developed in the capitalist West. He then posed questions such as ‘Has “The Welfare State” abolished poverty, social deprivation and exploitation?’ Some argued precisely this point, especially those social scientists propounding the ‘end of ideology’ –​that is, that a consensus on social and economic affairs had been reached in the Western democracies, and that economic growth had eliminated poverty, as manifested by the emergence, by the 1960s, of ‘The Affluent Society’. For Titmuss this was wrong on various counts, not least that it was ‘unhistorical’. In Britain there was growing evidence that income inequality had increased, not decreased, since 1945. It was necessary, therefore, to ‘find imaginative ways and new institutional means of combining humanity in administration with redistributive social justice in the future development of welfare policies’. In order to enable this, society needed ‘different rules domestically to live by; more examples of altruism to look up to’.18 Such a brief summary does scant justice to Titmuss’s arguments. But we can discern some of his principal concerns.These included scepticism about the free market (and, consequently, free-​market economists),

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and the need to locate contemporary social developments in their historical context. Notable, too, is that the advent of the ‘welfare state’ had not, contrary to certain current analyses, solved society’s problems, and indeed that some of these were increasing –​notably inequality. And we encounter for the first time in this volume Titmuss’s promotion of ‘altruism’, his belief that, at their best, individuals could care for the wellbeing of strangers, and that this could, and should, be promoted by the state acting on behalf of society as a whole. Social services could encourage such altruistic behaviour if properly constructed, and humanely and flexibly administered. One component of this was that ‘welfare professionals’ should act not in their own interests, but in the interests of those they served. Such issues underpinned Titmuss’s approach to welfare, giving his ideas considerable intellectual strength (as well as certain intellectual weaknesses). As to his aspirations for his emerging field,Titmuss told an American sociologist he frequently cited, Robert Merton, that ‘in thinking about the subject of social policy research’ he had been stimulated by one of Merton’s papers.19 Published in 1949, this had discussed the extent to which social science could, and should, influence policy. In a passage which may have especially appealed to Titmuss, Merton argued that the ‘higher the social standing of a discipline, the more likely it will be to recruit able talents, the greater its measure of financial support, and the greater its actual accomplishments’.20 By the time of Titmuss’s correspondence with Merton, 1957, he had recruited ‘talents’ such as Abel-​Smith, was actively pursuing research funding, and had already made a difference to policy making by way of, most notably, the Guillebaud Committee’s enquiry into NHS finances. There can be no doubt that Titmuss was viewed, at least on the liberal left, as pre-​eminent in analyses of the ‘welfare state’. This was further recognised in obituaries, and subsequent recollections. Marshall claimed that Titmuss had ‘exerted an influence, academic and political, at home and abroad, which has not been surpassed by any British social scientist of his generation’.21 Commenting on another aspect of Titmuss’s work, one often neglected, A.J. Isserlis pointed to his role in promoting better race relations through, especially, membership of the Community Relations Commission between 1968 and 1971.Titmuss’s approach was underpinned by ‘an awareness of the structural economic and social weaknesses in the community that created or threatened disadvantage for black, brown and white alike’.22 Tributes were not confined to Britain.The social policy writer and sometime US federal official, Alvin Schorr, in an edited volume on American child welfare services, observed that Titmuss had died while the collection was being

6

Introduction

completed. It was a ‘mark of his influence’, Schorr wrote, ‘that besides myself, three of the authors represented here in one way or another took instruction from him’.Taken as a whole, the volume variously expressed ‘three general points of view that (Titmuss) spent his life representing or exploring’, namely ‘an emphasis on the distributive consequences of social policy … a stubborn belief in altruism as a motive power for social policy … and a preoccupation with how individuals fare in social policy’.23 And, as we shall see, for some Titmuss’s legacy endures in the twenty-​first century.

Understanding Titmuss: David Reisman The present volume is the first full-​scale account of Titmuss’s life. But here we should acknowledge David Reisman’s pioneering work, first published in 1977. Outside of Titmuss’s daughter Ann Oakley’s partly biographical (and autobiographical) accounts, this is the only full-​length study of Titmuss’s ideas and, to a much lesser extent, his life.24 A second edition appeared in 2001.What did Reisman have to say? We can only give a flavour here, while acknowledging that much of what he argues, and his attempt to assemble a coherent account of what Titmuss was about, retains value. Reisman is complimentary about Titmuss in that he sees him as an ‘original, creative and sensitive thinker whose work has not always won the understanding it deserves’. He was, moreover, a ‘maverick and an outsider’. In terms of ideas, Titmuss was, for example, a ‘believer in voluntarism and getting involved’, unsurprising for someone who was a ‘committed communitarian’. Nonetheless, he had little to say about the voluntary sector’s role in welfare provision, in part because Titmuss derived his conviction from ‘value-​consensus’, arguing that ‘the citizen, where dependent, has a right to service. Voluntarism, however, is by its very nature discretionary’. Reisman also draws attention to what he considers some of Titmuss’s weaknesses. He ‘never saw the need to make his underlying system fully explicit’ (one of Reisman’s aspirations), while his argument that the Second World War had generated post-​1945 social reconstruction was inadequate when explaining other welfare systems. As Reisman puts it, ‘Titmuss was an English author. In describing the relationship between welfare and war, Titmuss knew that he was writing about his own country, and not about the whole of the race’. Concluding, Reisman suggests that nobody before or since Titmuss ‘has produced an intellectual map capable of situating and integrating so large a number of seemingly unconnected variables in the all-​encompassing inquiry into welfare and society’.25

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These selected extracts scarcely do justice to Reisman’s text. But they do raise analytical points, some with which the present author would agree, others not. That about war and welfare, for example, is well made, and contains significant elements of truth, while being more complex than Reisman allows. And it is certainly true that Titmuss was a ‘committed communitarian’. However, he was also committed to defending individual rights, and individual choice. Similarly, that Titmuss was an ‘English author’ is unarguable, although again something which can be further developed. As we shall see, Titmuss can be seen as belonging to a very English, radical, tradition.This is not to say, though, that he did not engage with welfare policies in other countries. Equally, a case can be made that Titmuss’s work has not always been fully understood, and he was certainly an unusual figure in post-​war British academic life. But was he really an ‘outsider’? It can be argued that he was, by his death, an ‘Establishment’ figure, although again this is not straightforward. Titmuss’s attitude to universalism, and discretion, meanwhile, was rather more complicated than is conventionally claimed, as was his attitude to voluntarism. And while it is true that Titmuss did not produce a work synthesising his approach to welfare, it is debatable whether he nonetheless produced an ‘intellectual map’, or at least one capable of rebuffing the increasingly demanding claims of neo-​liberalism. However, and as Reisman implies, Titmuss’s angular, and holistic, approach did provide him with original insights. So Reisman offers an important platform for our understanding of Titmuss; but more can be said.

Titmuss the person Many of those interviewed for this volume remembered Titmuss as supportive, personally and professionally, and as a compelling individual. It is clear, too, that younger colleagues such as Tony Lynes and Mike Reddin benefitted, at least in the first instance, from Titmuss’s encouragement. Similarly, while critical of the overwhelmingly middle class composition of the student population of his day, he was caring and thoughtful with individual students. In one of the most striking (and much quoted) depictions of him, the Labour politician Shirley Williams recalled ‘Richard Titmuss, the London School of Economics professor with the gaunt face and the burning eyes of an El Greco saint’.26 Williams was not unique in her reference to Titmuss’s looks in these terms, which, in fact, pre-​date her. But her portrayal of Titmuss is both powerful and has had a long shelf life. A.H. Halsey, sociologist and friend of Titmuss’s, likewise suggested the El Greco comparison,

8

Introduction

with Titmuss as an ‘ascetic divine’. But Halsey made the important qualification that Titmuss was no ‘saint, but a secular agnostic’. He was, though, a ‘remarkable figure’ who was ‘unsparing in his loyalty to his College and his country, a mark of integrity for the vast majority of those who knew him, whether at work in Houghton Street or at his modest home in Acton with his wife and daughter’. Reflecting on Titmuss’s time at the LSE, Halsey recalled that going to see him in his office would ‘always remain among my most vivid memories’. An ‘indefatigable and imaginative autodidact’, he continued to be, even after his 1972 election as a Fellow of the British Academy and numerous honorary degrees, a ‘devotee of the spirit rather than the conventions of academic institutions’.27 As Halsey suggests,Titmuss often went out of his way to welcome visitors to both the LSE and his home. He also provided advice and support where it was not strictly required. Given the unremitting pace of his own work schedule this was, to use one of his own key words, altruistic. A further, insightful, aspect of Titmuss’s character comes in a review of his second collection of essays, Commitment to Welfare, published in 1968. The reviewer was Donald MacRae, Professor of Sociology at the LSE. This was a sharp, although not unfriendly, critique, returned to in Chapter 20. But for present purposes what is important is that MacRae distinguished between what he called the ‘Roundheads’ of Social Administration and the ‘Cavaliers’ of Sociology.28 This notion of Titmuss as an ascetic, serious-​minded individual devoted to his work has much to commend it, and was one which he himself promoted. And although on one level an apparently flippant comment, MacRae’s distinction between the two fields hints at the tensions between their respective departments. Such tensions notwithstanding,Titmuss came to be highly regarded at the School, both as an academic and as someone called upon to play a part in its governance. The latter suggests a political player, not an El-​Greco saint. Famously, another LSE colleague, the conservative political philosopher Michael Oakeshott, described him as a ‘snake in saint’s clothing’.29 Titmuss also had his own, very human, foibles. His daughter, Ann, attended Haberdashers’Aske’s school, which she disliked.30 As Titmuss’s personnel files show, this was supported by an educational grant from the LSE which continued when Ann went to Somerville College, Oxford. In the first instance, the award was of £50 per annum, the present-​day equivalent of more than £1500. The same files reveal, too, that however hostile Titmuss was to private insurance companies, he always made sure his own occupational pension was up to the mark.31 These were exactly the sort of occupational ‘extras’ available

9

RICHARD TITMUSS

to middle class professionals which Titmuss would critique in works like The Social Division of Welfare, although it might be argued that he would have been foolish to turn them down. Titmuss was not above meals in West End clubs, nor in helping aristocratic ladies with their charitable activities. And, on the domestic front, Oakley records that it was Kay who did all the work, including child care.32 Titmuss was hardly the only man to play a limited domestic role in mid-​twentieth century Britain, but again this sits uneasily with his progressive, egalitarian, pronouncements. In his working life Titmuss, although supportive, as noted, nonetheless had an inner circle of male colleagues –​notably Abel-​Smith and, initially at least,Townsend. And what started off as a joke on Abel-​Smith’s part, that Titmuss was ‘God’, appears to have been taken more seriously by other department members. He had his acolytes. In the context of the LSE more broadly, two events were especially distressing to him, and further illustrate aspects of his personality. The first was his dispute with some female social work tutors in the mid-​1950s. Titmuss undoubtedly had strong working relationships, and relationships of mutual respect, with certain female academics and public figures. Notable among these were the social scientists Barbara Wootton and Dorothy Wedderburn, both of whom had made their way in academic life in difficult circumstances, given that it was then an overwhelmingly male-​dominated preserve. The hierarchical and gender-​biased nature of British academic life forms an important backdrop to Titmuss’s LSE career, and it is revealing that some have reported that he was supportive of female colleagues.33 Nonetheless, Titmuss undeniably had serious issues with certain social work staff. Was the underlying issue here his attitude to women, his own insecurities, or was it just another example of the departmental politicking common in academic life? The second series of events which particularly upset Titmuss at the LSE were ‘The Troubles’ of the late 1960s. Initially, these concerned the controversial choice of a new director, chosen by a selection committee which included Titmuss. The disruption spread, amid accusations of left-​wing troublemaking, leading at one point to the LSE’s closure.The broader context was student activism over issues such as the Vietnam War, and apartheid South Africa. Titmuss was a vigorous opponent of racial discrimination, and critical of American intervention in Vietnam. Indeed, in certain respects he was a typical member of the post-​war liberal-​left intellectual elite. The point, though, was that he stayed loyal to the School and its leadership, and continued to hold classes throughout the disruption and shutdown. Such loyalty did not necessarily, as some have suggested, represent a move to the political

10

Introduction

right. Rather, it might be argued that it showed personal courage, and an unwillingness to follow fashion.

This volume This biography does not attempt to cover every aspect of Titmuss’s life, or to catalogue, far less analyse, every item he published, committee he sat on, or event he attended. Although his personal life is not ignored, it has been dealt with at some length by Oakley. Rather, the volume seeks to place Titmuss’s life in its political, policy, and academic contexts, and to evaluate him in that light. This is not unreasonable, not least because of Titmuss’s own obsession, to put it mildly, with his work, and the almost unbelievably punishing schedule to which he submitted himself throughout his adult life. To give a further flavour of this, and simply to call attention to some of his activities during his last decade,Titmuss was a member of the Royal Commission on Medical Education, and of various race relations bodies. In 1967 he joined the Supplementary Benefits Commission (SBC), becoming deputy chairman the following year, a post he retained until his death. Along with colleagues including David Donnison, Robert Pinker, and Garth Plowman,Titmuss was on the Editorial Committee of the Journal of Social Policy, founded in 1972 as a publication of the Social Administration Association (later, Social Policy Association).34 In 1964 his friend Peter Shore, then at the Labour Party Research Department, asked him to comment on a draft paper, the ultimate outcome of which was the establishment of the Open University.35 In autumn 1965, meanwhile,Titmuss received a letter from Tony Crosland, Labour’s Secretary of State for Education and Science. Crosland had heard that Titmuss was to serve on the newly created Social Science Research Council (SSRC). In a hand-​written addition, Crosland noted that he was ‘very pleased that you are doing something for us in this Dept.’.36 The LSE’s director, in a memorandum to the appropriate LSE committee, commented that Titmuss, along with the anthropologist Raymond Firth and the statistician Claus Moser, had agreed to serve on the SSRC, and strongly recommended that this be duly endorsed. It was in both the national interest and the ‘interests of the School’ that the three professors take up their posts.37 Titmuss only served on the council for around a year (the appointment had been for three years), almost certainly because of the volume of his other commitments.38 Nonetheless, the original invitation was a clear indicator of his standing. More obscurely, although reflecting his broader social concerns, Titmuss agreed to sponsor the Concord Films Council, a body

11

RICHARD TITMUSS

dedicated to using film to promote peace ‘and particularly to relate massive arms expenditure to the needs of the under-​privileged and underfed peoples of the world’. Other sponsors included the playwright Arnold Wesker and the journalist Ritchie Calder.39 Of course, on occasion Titmuss turned down requests. One of the more implausible came in 1963 from Bishop Thomas Craske who told him that the Church of England was investigating why young men did not come forward for ordination. ‘It would help us greatly’, the Bishop wrote, ‘if you could, in the light of your own experience and conversations with young men, let us have your views on the subject.’ The non-​believer Titmuss declined on the grounds of insufficient knowledge.40 All this (and there was much, much more) was undertaken while holding a full-​time post at the LSE, and producing a stream of publications. Such a relentless pace surely affected his health, poor from childhood. It also raises the question of what sort of life he had outside work.The central point is, again, that Titmuss should be seen, and saw himself, as a public figure, and it is in that light that the bulk of this volume is constructed. To make my own position clear, I  firmly believe that historical insights can constructively inform contemporary policy debates.41 Understanding a major figure in post-​war Social Policy can, and should, help illustrate how we might better contribute to the kind of discussions taking place in the first decades of the twenty-​first century, many of the issues with which Titmuss grappled still being with us.This is not to say that the solutions he offered to the problems of his own times were necessarily ‘right’, or can be unthinkingly transferred into a much-​changed world. Nonetheless, asking the appropriate questions, and attempting to evaluate Titmuss’s analyses, can illuminate both change and continuity in welfare policy formation and practice, and the nature of the social problems which such policies seek to address. The remainder of the volume is divided into six parts. The first, ‘Early Life and Career to the End of 1941’, embraces Titmuss’s origins, limited formal education, and marriage to Kay. His employment in commercial insurance, political commitments, research into population and population health, and relationship to ‘progressive opinion’ in the 1930s and early 1940s are then discussed. The second part, ‘From Problems of Social Policy to the London School of Economics’, covers the period from 1941 to 1950, and begins with a major shift in his career, his engagement to write Problems of Social Policy. This did not, however, keep Titmuss from other activities, scholarly and otherwise. For instance, he continued his involvement with the Eugenics Society, begun before the war. He was also developing a significant media presence, both through publications and on the radio. Part II ends

12

Introduction

with Titmuss’s LSE appointment, and his inaugural lecture wherein he outlined his plans for ‘Social Administration’.Titmuss’s only child,Ann, had been born in 1944, and his new career was to impact not only on Titmuss himself, but also on Kay and their daughter. In Part III, we examine Titmuss’s ‘First Decade at the LSE’. In this period he gave a number of public addresses articulating some of his key preoccupations. His growing fame, and influence, led to work for official bodies such the Guillebaud Committee, which examined the finances of the NHS. He also became increasingly involved with the Labour Party, particularly its attempts to reformulate its pensions policy. Titmuss was, as his inaugural lecture had intimated, keen to build up research in the Department of Social Administration. But there were problems in the 1950s over the training of social workers, an unhappy episode in Titmuss’s career. More positively, his already impressive publication record was further enhanced by two important works, Essays on ‘The Welfare State’ and The Irresponsible Society. Part IV, ‘Power and Influence: Titmuss 1960 to 1973’, is the longest, dealing as it does with Titmuss at the height of his powers.We start off with his role in tributes to an individual whom he greatly admired, the historian and ethical socialist R.H.Tawney.Titmuss also took an interest in mental health, one reason why he was invited by the Labour government to join the Royal Commission on Medical Education. He was in demand abroad as well, and his work in Mauritius,Tanzania, and Israel is duly examined. Back home he had a significant input to the reform of Scottish social work, and this complemented his engagement with the Seebohm Committee, set up in 1965 to report on local authority social services. A  further contribution to public life came through membership of the Finer Committee, concerned with the problems facing one-​parent families. Nor did he stop publishing and writing. Part IV also embraces Titmuss’s engagement with the United States. Sometimes seen as an archetypal Englishman (he loved gardening and cricket), Titmuss’s interest in welfare systems outside Britain has been somewhat overlooked. In recognition of his public service, Titmuss was made CBE, at Prime Minister Harold Wilson’s nomination, in the 1966 New Year’s Honours List.42 Like its predecessor, Part  V,  ‘Troubles’, deals with Titmuss in the 1960s and early 1970s, but here the emphasis is on issues which caused him considerable upset.Titmuss’s tenure at the Supplementary Benefits Commission was marked by his loyalty to that body, its policies, and its staff, all of which he defended against what he saw as unwarranted criticism, often from people he considered friends. Challenging, too, was the issue of race relations. Titmuss had a track record of opposing

13

RICHARD TITMUSS

hostility to immigrants, and discrimination, and his support for the Labour government was put under strain by certain of its policies. Titmuss was also an opponent of the Vietnam War, and, closer to home, of Britain’s attempts to join what was then called the Common Market. But of even greater concern was, first, his longstanding dispute with the IEA over the role of the market in healthcare provision. This was extremely stressful, although it had a positive outcome in that it spurred Titmuss to produce what turned out to be his last major work, The Gift Relationship. Second, even closer to home Titmuss was a major participant in the so-​called ‘Troubles’ which beset the LSE in the late 1960s. He resisted what he saw as bullying, and ill-​informed, behaviour by staff and student protestors. Titmuss’s always fragile health took a turn for the worse in the early 1970s, and Part V concludes with his death, and its aftermath. Finally, in Part VI, an attempt is made to assess Titmuss’s life and work. Notes 1 R.M. Titmuss, ‘Social Administration in a Changing Society’, British Journal of Sociology, 2, 3, 1951, p 189. Reprinted in Essays on ‘The Welfare State’. 2 R.M. Titmuss, Poverty and Population, London, Macmillan, 1938. 3 R.M. Titmuss, ‘Role of the Family Doctor Today in the Context of Britain’s Social Services’, The Lancet, I, 1965, p 1. 4 Most social policy academics see their subject as a ‘field’ rather than a ‘discipline’. I am grateful to, especially, the late Professor David Donnison (interviewed by the author 4 December 2015 and 11 February 2016), for clarifying this point. 5 Oakley, Man and Wife, p 202. 6 T.H. Marshall, Social Policy, London, Hutchinson, 1965, p 7. 7 J.E. Meade, ‘Poverty in the Welfare State’, Oxford Economic Papers, 24, 1972, pp 289–​326. 8 G. Howe, ‘The Fabian Threat to Freedom’, The Daily Telegraph, 4 January 1967, p 14. 9 R. Miliband, ‘The Sickness of Labourism’, New Left Review, 1, 1, Jan/​Feb 1960, pp 5–​9. I owe the point about Miliband’s attitude to Titmuss’s Department to Professor Jose Harris. 10 A. Seldon, ‘Ideas Are Not Enough’, in D. Marquand and A. Seldon (eds), The Ideas That Shaped Post-​War Britain, London, Fontana, 1996, p 268. 11 D. Donnison, ‘The Academic Contribution to Social Reform’, Social Policy and Administration, 34, 1, 2000, pp 34, 37. 12 S. Thornton, ‘Richard Crossman, the Civil Service, and the Case of the Disappearing Pension’, Public Policy and Administration, 20, 2, 2005, pp 67–​80. 13 D. Piachaud,‘Titmuss –​Teacher and Thinker’, New Statesman, 13 April 1973, p 521. 14 TITMUSS/​7/​68, letter, 8 May 1960, Martin to RMT. 15 D. Edgerton, Warfare State: Britain, 1920–​1970, Cambridge, Cambridge University Press, 2006, p 216ff. 16 R. Crossman, The Politics of Pensions: Eleanor Rathbone Memorial Lecture, Liverpool, Liverpool University Press, 1972, p 7.

14

Introduction 17 M. Hough, ‘Bibliography of Published Works by Richard Titmuss’, in R.M. Titmuss, Poverty and Population: Volume 1 of the Palgrave Macmillan Archive Edition of the Writings on Social Policy and Welfare of Richard M. Titmuss, Palgrave Macmillan, Basingstoke, 2002, pp xxi–​xxxv. 18 R. Titmuss, ‘The Limits of the Welfare State’, New Left Review, 1/​27, Sept/​Oct 1964, pp 28, 30, 31, 33, 35, 37. 19 TITMUSS/​7/​65, letter, 17 July 1957, RMT to Merton, Columbia University, New York. 20 R.K. Merton,‘The Role of Applied Social Science in the Formation of Policy: A Research Memorandum’, Philosophy of Science, 16, 3, 1949, pp 161–​81, p 164. 21 T.H. Marshall, ‘Richard Titmuss: An Appreciation’, British Journal of Sociology, 24, 2, 1973, p 137. 22 A.J. Isserlis, ‘Richard Titmuss: 1907–​73’, Journal of Ethnic and Migration Studies, 2, 2, 1973, pp 185–​6. 23 A.L. Schorr, ‘Introduction’, in A.L. Schorr (ed), Children and Decent People, New York, Basic Books, 1974, p xvi. 24 D. Reisman, Richard Titmuss: Welfare and Society, London, Heinemann, 1977, with Preface by R. Pinker. Oakley’s main works pertaining to her father’s life are Man and Wife, and Father and Daughter. 25 D. Reisman, Richard Titmuss: Welfare and Society, Basingstoke, Palgrave, 2nd edn 2001, pp 4, 5, 64–​5, 67, 4, 197, 269. 26 S. Williams, Climbing the Bookshelves:  The Autobiography, London, Virago, 2009, p 138. 27 A.H. Halsey, No Discouragement: An Autobiography, Basingstoke, Macmillan, 1996, pp 58, 216. Houghton Street is still one of the LSE’s main thoroughfares. 28 D. MacRae, ‘Roundheads’, New Statesman, 1 July 1968, pp 175–​6. 29 Cited in Oakley, Father and Daughter, p 244. 30 Ibid, pp 21–​3, 92. 31 See, for example, LSE/​Staff Files/​Titmuss, R.M. Titmuss, ‘London School of Economics and Political Science, Educational Allowance, Application for the year ended 31st July 1952’ ‘London School of Economics and Political Science, Educational Allowance, Application for the year ended 31st July 1965’; and, on occupational pensions, the correspondence between the School, the University of London, the Alliance Assurance Company, and the Inland Revenue, spring 1958. 32 Oakley, Father and Daughter, p 8. 33 Interviews with Professor Pat Thane, a PhD student in the LSE Social Administration Department in the1960s, 9 March 2016; and with Professor Jose Harris, one of Titmuss’s doctoral students, also 1960s, 18 July 2016. 34 M. Powell,‘Social Policy and Administration: Journal and Discipline’, Social Policy and Administration, 40, 3, 2006, p 239. 35 TITMUSS/​7/​72, letter, 15 May 1964, Shore to RMT. 36 LSE/​Staff File/​Titmuss, letter, ? October 1965, Crosland to RMT. 37 LSE/​Staff File/​Titmuss, memorandum, undated but October 1965, Sydney Caine to School Standing Committee. 38 LSE/​Staff File/​Titmuss, letter, 21 November 1966, RMT to Caine. 39 TITMUSS/​7/​71, letters, 29 June 1963, Concord Films Council to RMT; and 3 July 1963, RMT to Council. 40 TITMUSS/​7/​71, letters, ? July 1963, Craske to RMT; and 1 August 1963, RMT to Craske.

15

RICHARD TITMUSS 41 For this type of approach see ‘What We Do’ on the website of the organisation History and Policy, www.historyandpolicy.org; also M.  Powell and J.  Stewart, ‘Themed Section on History and Policy: Introduction’, Social Policy and Society, 4, 3, 2005, pp 293–​4. 42 ‘The New Year Honours’, The Times, 1 January 1966, p 5.

16

Part 1

EARLY LIFE AND CAREER TO THE END OF 1941

2 ‘As the son of a farmer…’: origins, early employment, and personal life Introduction Titmuss’s early life, unremarkable in many respects, has nonetheless been the subject of dispute. Shortly after his death Margaret Gowing, a friend with whom he had worked during the Second World War, produced an account of his life which has proved influential for how Titmuss has since been viewed.1 Gowing’s narrative remains important, and will be drawn upon in what follows. In certain respects, however, Gowing’s was a partial account which consolidated the by then standard view of Titmuss’s origins and career. Put simply, this stressed the deprivations of his childhood and youth, so throwing into sharp contrast his eventual place as Britain’s leading authority on social policy, an expert advising governments at home and abroad, and public intellectual. For instance, a sympathetic profile in The Observer in 1959 noted the challenges Titmuss’s family had faced, and how Titmuss himself claimed to have learned little at school, save an enduring love for cricket and football.2 A few years later, another newspaper article suggested that the origins of ‘The Poverty Lobby’ of the 1960s lay in the early hardships of one of its members,Titmuss.While colleagues such as Abel-​Smith were middle class, and had come to socialism ‘by conviction’, Titmuss had reached this position ‘by experience’.3 The last point begs more questions than it answers, not least the nature of Titmuss’s political beliefs. In his application for the LSE chair in 1950 Titmuss said little of his formal education save that, ‘As the son of a farmer’, he had been sent to ‘a preparatory school in Bedfordshire which drew most of its pupils from farmers in the district’. At 14 he was then sent to Clark’s

19

RICHARD TITMUSS

Commercial College for six month to learn bookkeeping.4 The downbeat account of Titmuss’s early years was most vigorously promoted by his wife, Kay. Shortly after his memorial service in June 1973, she told an American friend who had spoken at the event that Titmuss’s ‘only schooling was at a private school of poor quality from which he was frequently absent due to ill health in childhood’. ‘And’, she continued, ‘he knew what it was to be on the poverty line when he struggled to keep the family going after his father’s death on a mere pittance of an insurance clerk’s salary’.5 Kay’s comment about Titmuss’s health reminds us that this was certainly a feature of his childhood, but also of his whole life. And the idea that Titmuss was, as a consequence of his early hardships, especially sympathetic to the poor is a variant on the notion that he came to ‘socialism’ through ‘experience’, and is likewise questionable. And here lies the problem. Ann Oakley has disputed aspects of Gowing’s account of her father’s origins and subsequent career, substantiating her case with archival and other evidence.What Gowing wrote, she argues, was ‘weakened by its reliance on the singular perspective’ of Kay. Kay’s concern had been to highlight ‘how important she had been to (Titmuss’s) success and how unimportant, indeed damaging, had been the contribution of his own family’. Such a narrative was attractive as it appeared to show ‘this champion of equality and the welfare state transcending his own impoverished background through sheer hard work, a truly self-​made man’.6 And it was not only Kay who promoted this somewhat self-​regarding version of Titmuss’s life, so did many of those around him, and influenced by him. The entry in Oxford Dictionary of National Biography, for instance, written by his friend A.H. Halsey, suggests that the Titmuss family ‘lived an isolated and impecunious life in Bedfordshire’, that Titmuss never took a formal examination in his life (a fact he allegedly did not regret), and that he instead preferred to ‘applaud the public library as the most precious of British social services’. Halsey suggests, too, that Titmuss’s ‘first step out of obscurity was made in 1934’ when he met his future wife, Kay.7 Parts of this are, to say the least, debatable. Oakley certainly has the advantage over Gowing in her access to her parents’ papers, some of which are not in the public domain.8 To be fair, Gowing acknowledged that she had spoken extensively with Kay, noting her especial gratitude for access to ‘Richard’s voluminous records’. But she also, as her memorial noted, spoke to others.9 For instance, in a letter to Walter Adams, LSE director, she thanked him for ‘spending so long in talking to me about Richard Titmuss and for sending me the information’.This would be extremely useful in the preparation

20

‘As the son of a farmer…’: origins, early employment, and personal life

of her article, of which she would send him a draft. Gowing agreed not to refer directly to correspondence which Adams had shown her.This concerned Titmuss’s appointment at the LSE, and in particular T.H. Marshall’s recommendation.10 Nonetheless, as Howard Glennerster remarks, Oakley’s research has dispelled some of the ‘myths’ about Titmuss’s early life. It, too, provides a crucial source for what follows.11 This chapter attempts to steer a path through the rather scant evidence about that early life. First, Titmuss’s origins and childhood are examined. Then his entry into employment is described, and specifically his work for the County Fire Office. Next comes a discussion of Titmuss’s life outside employment. While Titmuss’s political and research activities in the 1930s are alluded to, they are dealt with more fully in subsequent chapters. Perhaps the central point, though, is that the degree to which Titmuss’s early years were, or were not, deprived should not unduly colour an indisputable fact –​that he went, in the course of half a century, from being an insurance clerk to being an internationally recognised authority on social welfare.

Birth, childhood, and youth Titmuss was born on 16 October 1907, son of Morris, at this point a farmer, and Maud, née Farr.12 Titmuss had an older sister (who pre-​ deceased him), and, later, a younger brother (another sister died in infancy).The family home was Lane Farm in Stopsley, a hamlet north of Luton in Bedfordshire. Here wheat, barley, oats, and beans were grown in clay soil. In addition to its Anglican church, Methodists and Baptists also had a local presence.13 Bedfordshire had a strong Nonconformist tradition, being a parliamentary stronghold in the English Civil War as well as home to another famous son, the writer and polemicist John Bunyan. There is no evidence that Titmuss was in any way religious (although he was married in an Anglican church and his memorial service was held in one too, probably at Kay’s behest). Nonetheless, he cannot have been unaware of the cultural surroundings in which he grew up. And, while unprovable, his commitment to the Liberal Party may have owed something to this dissenting cultural context. More broadly, we can also find a fit here with the notion of Titmuss as a radical of a peculiarly English sort. It is intriguing, too, that, according to Oakley, Titmuss retained an affection for rural Bedfordshire.14 Gowing suggests that the Titmuss children led an isolated life, but were free to roam the surrounding countryside. Titmuss’s education came at St Gregory’s, the preparatory school disparaged by Kay.15 But as Oakley sensibly points out, although the school did seem to prioritise

21

RICHARD TITMUSS

sport, its ambitions to send pupils on to public schools –​it was, after all, a preparatory school –​suggests rather more academic rigour than is allowed in the usual accounts of the Titmuss ‘myth’.16 Nonetheless, Titmuss’s early education was probably less than satisfactory, partly because illness curtailed his school attendance. By Gowing’s account, Titmuss’s parents were not up to much. His mother is presented as ‘incompetent domestically’, although if this was part of the story which came from Kay it should be treated with care for, as we shall see, she was no admirer of her mother-​in-​law. Morris, meanwhile, is portrayed as failing as a farmer. This precipitated a move to Hendon, North London, in 1922, where he set up a haulage business. Again, this is generally portrayed as unsuccessful.17 It would certainly appear that Morris Titmuss was not in the vanguard of British entrepreneurship. But the context is also important. After the First World War an agricultural depression took hold, with prices for crops such as wheat falling dramatically, while the limited measures of protection accorded to agriculture were abolished in 1921.The British economy as a whole, following a post-​war boom, began to contract from the early 1920s onwards although, to balance this, London and the South East were largely spared the miseries of the inter-​war slump. Morris may have been feckless, or unlucky, or, most probably, a combination of the two. But, as Oakley observes, he was able to leave farming without leaving any debt behind, continued to pay at least his older son’s school fees, and bought the Hendon house. The last was an end-​terrace building which would have been, in Oakley’s words,‘sparklingly new then’, part of the suburban expansion London was then experiencing. Home ownership was, at this time, characteristic not of the working class, most of whom rented, but rather the middle class. So perhaps Morris was not so feckless after all. In any event, the move to Hendon saw the end of Titmuss’s time at St Gregory’s (which was about to happen anyway), and the start of his short time at Clark’s Commercial College, situated at Chancery Lane in Central London.18 Coincidentally, this was close to the institution where Titmuss would come to play a leading role, the LSE. Following his bookkeeping course, he was then employed by Standard Telephones, based in North London, as well as helping out with his father’s business. However, in 1926 Morris died.According to an insurance policy application which Titmuss made some 40 years later, his father’s cause of death was angina, from which he had suffered for ‘some months’ (in a very un-​Titmuss like mistake, he got Morris’s year of death wildly wrong).19 This did pose financial problems, although again Oakley suggests that the ‘extent of the family’s poverty had perhaps been

22

‘As the son of a farmer…’: origins, early employment, and personal life

a little exaggerated’. Nonetheless, this was a life-​changing moment for Titmuss. Through a contact of his mother’s, he was taken on, initially as a probationary clerk, by the County Fire Office. Titmuss, still only in his late teens, now became the family bread-​winner.20 His mother, from now until her death in 1972, relied on him as her sole source of financial support.21

Employment The County Fire Office had been founded in 1807 and, by its own account, was an ‘association of noblemen and gentlemen’. It was one of 19 such companies founded in the first decade of the nineteenth century, a testament to contemporary trends in industrialisation and urbanisation. As Harold Raynes notes, it had ‘some individual characteristics’, and sought to ‘seek support from the counties where there was a demand for fire insurance and a desire for local responsibility’. Around the time Titmuss joined, the company had acquired a new building at 30 Regent Street, in London’s West End.This was the office to which Titmuss was to commute for the next decade and a half. The First World War and its aftermath brought considerable changes to the County Fire Office, including the employment of women, and the range of coverage it offered.Various staff benefits were introduced, including schemes to assist with house purchase, and a staff canteen. The company clearly saw itself as progressive, with many staff enjoying long periods of service.22 Whether Titmuss (or any of the other staff) felt the same way is open to question. By the time he came left he had become increasingly disgruntled with his insurance career, notwithstanding his promotion, at the relatively young age of 32, to London Inspector a few years earlier.23 As later chapters show, even before this point he was devoting much of his time to political activities, and to research on population issues. And as a profile written in the 1960s suggested, once promoted to inspector he could ‘do his inspecting at home by phone in the mornings which left the afternoons free for study’.24 Presumably, this information was provided by Titmuss himself. But back at the beginning of his insurance career, he was initially paid £85 per annum, rising by £20 per annum to, ultimately, £265 per annum. Gowing, as we have seen, was sceptical about Titmuss’s formal schooling, suggesting that he was largely ‘self-​educated with a special interest in working out mathematical problems’.25 Again, this presumably came, by way of Kay, from Titmuss himself but he clearly had, and further developed, mathematical skills. As Oakley suggests, at County Fire Office he learned

23

RICHARD TITMUSS

‘not only the essentials of the insurance business but how to read and analyse the statistics of life, death and sickness’.26 Titmuss’s own early research was very much into such issues of morbidity and mortality. It is difficult to know whether Titmuss actually enjoyed any of his time at County Fire Office, as opposed to learning a lot from it. As will become apparent later in this volume, though, the private insurance industry was to become something of a bête-​noire on account of its purported economic power, and its promotion of benefits, notably occupational pensions, outside of state-​provided welfare. In Chapter 15, for example, we shall see how this shaped one of his most famous publications, The Irresponsible Society. His criticisms were, then, those of an informed insider. As a worker in the insurance industry, where, then, was Titmuss located in the social structure of inter-​war Britain? We have seen that one version of his early life stresses the modesty of his background. But after joining County Fire Office, Titmuss’s occupation, and to a lesser extent his income, placed him squarely in the middle class, albeit initially very much at its lower end. More than this, he was part of the ‘new’ middle class, broadly ‘progressive’ in outlook, and so of a different disposition to the ‘old’ middle class consisting of professions such as doctors and lawyers. Titmuss’s career in insurance, furthermore, coincided with what Ross McKibbin has characterised as a sort of middle class ‘golden age’. Stable and rising salaries, such as that enjoyed by Titmuss, combined with falling prices and an undemanding fiscal regime, meant that this social group was especially economically advantaged, while the threat of unemployment was considerably less than that faced by the manual working classes.27 Titmuss’s training was very much ‘on the job’, but, as we shall see further in a later chapter, he was clearly a good enough statistician to be elected a Fellow of the Royal Statistical Society, and to gain a grant from the Leverhulme Trust for his research, albeit largely on the basis of his published rather than professional work. Nonetheless, the two were clearly complementary, and that Titmuss was promoted to inspector at a relatively young age further attests to his abilities. The field of statistics itself can be seen as part of the ‘triumph of science-​based expertise’ which had taken place between 1880 and 1929. It had effectively been created by Karl Pearson, a leading figure in a movement with which Titmuss too was to be associated, eugenics.28 The further twist here is that Titmuss was later to express scepticism about aspects of the work, and behaviour, of ‘experts’ and ‘professionals’. But throughout his career he continued to employ statistical techniques and data, data which he clearly saw as hard, scientific evidence for the sort of moral arguments he sought to make.

24

‘As the son of a farmer…’: origins, early employment, and personal life

Marriage and private life At the memorial service held for Titmuss shortly after his death one of the speakers was Richard Crossman.While Crossman mostly talked, understandably, about Titmuss’s public activities, he also claimed that ‘Richard’s home life was an inspiration not only to him but to those of us who partook of Kay’s hospitality’. The two were similar types, he suggested, for example in their naivety in certain (unspecified) matters.29 Kay wrote a few days later to thank Crossman for his contribution. It was ‘hard to face the future without Richard and sad that he had to leave us when there was so much he still wanted to do’.30 The view of the Titmuss marriage as a close, loving, partnership has long been another part of the standard narrative of his life. Gowing, for instance, talks of the ‘deep love’ between Titmuss and Kay, and that this was the ‘mainstay of his life to the very end’.31 Again, given that she gained much of her information from Kay, this sort of depiction is to be expected (although, of course, that does not make it untrue). And to be fair, Gowing had known Titmuss for around 30 years by the time of his death. Of their respective personalities, Kay, at least for some, was an individual difficult to warm to, while Titmuss, for those who did not buy into his mission, could be vain and arrogant.32 Oakley quotes Townsend as claiming that he found Kay ‘small-​minded –​someone who often made carping or destructive comments about others and who did not have interesting things to say about her own activities’.33 Abel-​Smith helped Kay after Titmuss’s death until her own death 15 years later. But he later confided to Oakley that he had never really liked her mother.34 Given that Titmuss left few personal papers, and was famously reticent about private matters, it is difficult to know what to make of all this. The following account of his life outside work in the 1930s is, therefore, for the most part confined to factual material. Starting with leisure activities, as a young man Titmuss played chess to a reasonable standard (although he was to give it up as too time-​ consuming), and was a fan, and player, of both cricket and football.35 The former, in terms of its cross-​class appeal, was England’s ‘national’ sport, and an important component of English national identity.Among Titmuss’s other leisure activities was hiking and youth hostelling, in Britain and abroad. He was thus part of a broader trend in the 1930s which saw a shift from formal (that is, rules-​based) sport to, as McKibbin puts it, ‘more informal and socially casual activities’. At the end of the decade, there were ‘about 500,000 regular walkers and nearly 300 youth hostels’, with membership of the Youth Hostel Association rising from 6,000 in 1934 to 83,000 in 1939. This rapid expansion had a number

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of causes, including a growing perception of the countryside as a recreational resource, something which reminds us of Titmuss’s fondness for rural Bedfordshire. Both the middle and working classes took up pastimes such as hiking, with part of the appeal being that a more or less equal number of men and women participated.36 It was on such a walking tour of North Wales that Kay and Titmuss first met, in summer 1934. She had been born in South London on 20 January 1903, and was thus four years older. As was common at that time, both still lived at home, Titmuss with his mother in North London, where he was to remain until his marriage in 1937. Clearly both Kay and Titmuss were keen walkers, undertaking in 1935, for example, a tour of the Black Forest in Germany. Nor were their leisure activities confined to the outdoors. In a letter to a friend in 1935 Kay wrote that, though not interested in politics herself, she had agreed for Titmuss’s sake to attend a meeting at which he was speaking. Titmuss was by this point, as described in the next chapter, active in Liberal Party politics, not least by way of the debating society to which he belonged, the Fleet Street Parliament (again, coincidentally, close to the LSE). But Kay had not been impressed by the meeting, and this caused what turned out to be a temporary division between them, with her religious beliefs adding to the mix. Soon afterwards, though, they were planning their wedding. Titmuss’s political activities also included campaigning for a peaceful solution to international problems. Both he and Kay, again before their marriage, attended the World Youth Congress and International Peace Conference in Geneva in summer 1936. Titmuss was a delegate to both meetings, representing the National League of Young Liberals and Youth House, Camden. Closer to home, Kay and Titmuss also attended another youth peace conference in the same year, this time in Birmingham.37 Amidst all this, Titmuss also found time to write a work, in 1936, principally entitled ‘Crime and Tragedy’, but with the alternatives ‘Government by Betrayal’ and ‘Creation of Anarchy’. Written under the pseudonym Richard Caston (Caston was Kay’s middle name) this was rejected by various publishers. By Gowing’s account, the work was informed by his ‘new found radicalism’, implicitly attributed to Kay.38 Although this is difficult to substantiate one way or another, what is notable about this volume is that Titmuss had clearly been gathering material for some time, going back at least six years. This strongly suggests that concern about the issues with which his script dealt, primarily Britain’s foreign and defence policy since 1931, pre-​ dated his meeting Kay. What it had to say is discussed more fully in the next chapter, but here it is worth noting Titmuss’s take on patriotism.

26

‘As the son of a farmer…’: origins, early employment, and personal life

This was ‘not synonymous with the state of the country’s armaments and defence forces’. His own ‘love for my country is not pride in her ability to make war. It cannot be defined’. Nor was he hostile to the British Empire. On the contrary, one of his most stinging criticisms of the post-​1931 Conservative-​dominated government was that it had refused, in its foreign policy, to ‘accept the challenge to prove that Britain is fitted to fill the role and responsibility of a great power and of a great Empire’.39 Even when married, Titmuss, and Kay, kept up a relentless schedule of activities. In a letter to a friend, Kay wrote that a number of pieces of Titmuss’s correspondence to various newspapers and journals had been published, and more were being prepared.The previous evening, she continued, she had come home around midnight ‘to find all the lights on in the flat and the wireless on and Richard fast asleep in bed with a book in his hand. It seemed most odd’.40 By his own account, in the decade before starting work on Problems of Social Policy in the early 1940s,Titmuss had been ‘reading and studying privately’, had ‘attended evening classes at various institutes’, and, crucially, had ‘interested myself in social and economic questions’.41 We can already see here some of Titmuss’s defining features, which in many respects he retained for the rest of his life. He had a relentless drive for self-​improvement, became engaged in numerous activities by way of a range of associations and clubs, and was increasingly committed to political and social activism. He (and Kay) was thus participating in what McKibbin describes as the ‘informal sociability’ characteristic of the inter-​war middle classes (this is contrasted with the supposedly ‘spontaneous sociability’ of the working classes). An important feature of ‘informal sociability’ was joining clubs through which friendship, and sometimes professional, networks were created.42 Networking was to become a notable Titmuss trait.Although it raises a whole range of other issues, it is perhaps worth noting in this context Oakley’s observation, which pertains mostly to her parents’ post-​war lives, but may be revealing about even the early stages of their marriage. She debates whether, in the last resort, her father had any friends. His diaries, to which she had access, essentially record meetings and other work-​related activities. So ‘he might have been lonely. They were both lonely, the way you can only be lonely in a publicly successful marriage’.43 How did this marriage come about? After a certain amount of procrastination, with money almost certainly being a concern, Kay and Titmuss married on 6 February 1937 at an Anglican church in Lewisham, South London. Their first home together was a flat in Pimlico.44 Financial frugality seems to have been built into the

27

RICHARD TITMUSS

relationship, with Oakley claiming that her parents ‘were always careful with money: in fact it’s a bit of a puzzle what they spent their money on’. On a more personal level, and in what was to be a longstanding source of uneasiness in Titmuss’s life, Kay and his mother did not get on, with the latter also making constant emotional demands of him.45 As to what Kay did, when Titmuss met her she was the organising secretary of the Fulham Fellowship for the Unemployed, and later its honorary secretary and treasurer, from 1932 until its demise in 1940. She also took on other, related, roles. So Kay was in employment for a number of years of married life. But after 1940 she never again worked outside the home.46 This brings us back to the problematic issue of the nature of the relationship between Kay and her husband. Oakley suggests that the six years between Kay’s first meeting Titmuss and her leaving employment was her mother’s ‘golden period’. Kay was certainly busy with her own work, which in some ways was more socially significant than her husband’s at this point, but, and part of her later Titmuss mythology, in her view she was also leading him towards his true destiny as a leading thinker on social welfare.47 Gowing further elaborates on Kay’s role by suggesting that, from the time they had met, and under Kay’s influence, ‘Richard’s interests had become social and political’, the ‘new found radicalism’ noted earlier.48 In other words, Kay’s project was to be shaping, supporting, and promoting Titmuss’s career. A particular version of Titmuss’s life and work was put forward by Kay until the end of his life, and has had a shelf-​life beyond.This was Kay as the defender of the faith, defender of a man who had risen from poverty, formulated, with her background but essential assistance, new ways of thinking about social welfare, and was, to those of a like mind, someone to be loved and admired. Again to quote Oakley, when invited, with Titmuss, to a Buckingham Palace garden party in 1970, Kay ‘treasured this day, just as she treasured all Richard’s claims to fame’.49 And as Kay told Walter Adams shortly after Titmuss’s memorial service, at that event ‘it was wonderful to have so many friends gathered in St Martin’s and we were honoured and comforted by the consciousness of so much warmth and sympathy around us’. It had ‘meant a great deal when one has lost so much’.50 For Oakley, all this was to the frustration of her mother’s unacknowledged desires. She agrees that Kay ‘never said to me that, had she not married Richard Titmuss, she might have had a satisfying career of her own’. However, the ‘documentary remnants of her life bequeathed to me and the way she talked about the past, that past before I was born, did speak wistfully of an uncompleted journey’.51

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‘As the son of a farmer…’: origins, early employment, and personal life

We should pause momentarily to unpick some of this before examining Titmuss’s own attitude to marriage. On the question of Kay’s influence, it was certainly the case, as Gowing suggests, that in his first published book, which came out in 1938 and is discussed in Chapter 4, he acknowledged his wife as having given him insights into the lives of the unemployed. But Gowing over-​reads this when she writes that Kay had made ‘social values and social concerns his central issue’.52 Politically, Kay herself was no radical. As we have seen, in 1935 she claimed no interest in politics, and this had caused a certain coolness between her and Titmuss. Titmuss was politically aware enough to have joined the Liberal Party in 1932, before he encountered Kay. To reiterate an earlier point, it thus seems improbable that the activism Titmuss was displaying by 1935 had been solely caused by meeting Kay. Ultimately, we can never know the true extent of Kay’s influence on her husband. But from the Second World War onwards she was certainly to provide him with a domestic platform which allowed him to pursue his relentless work schedule. Back in the 1930s, though, it is undoubtedly true that Kay had direct experience of working with the unemployed.This may well have been important for Titmuss since locally unemployment rates were low. Looking round him,Titmuss would have seen a region, London and the South East, where new industries were thriving, the suburbs expanding (he lived in one himself), and the small number of unemployed were relatively invisible. Kay may, therefore, have alerted him to problems on his doorstep of which he had been unaware in a strictly personal sense (although he could not conceivably have been ignorant of the devastation being wrought on the traditional industrial areas). As to Kay giving up her career in order to support Titmuss, there is clearly a case to be made. But, as always, it is important to see this in context. Kay was actually unusual in continuing to work after her marriage, albeit for only a few years. In the inter-​war era only 10 per cent of the workforce consisted of married women, a group which constituted 16 per cent of the female workforce. The huge change in this situation was to come after the Second World War, and was analysed by, among others,Titmuss.53 Kay may have been thwarted in her career, but hers was, nonetheless, not an unusual experience.This is not to condone it, simply to suggest that the picture is complex. Oakley’s ‘uncompleted journey’ was not confined to Mrs Titmuss. Yet for Oakley, Titmuss had, for various reasons, a ‘passion for the stable breadwinner-​father formula of family life’  –​he was, and remained, in other words, a supporter of the ‘traditional’ family.54 She agrees that he was, in important ways, a radical who analysed to effect

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various social divisions. But when it came to gender it was ‘as though for him the social divisions between men and women were different from all other social divisions.They were not about power’.55 What she is arguing here is that while Titmuss was clear-​sighted about, say, the way in which social inequality involved the exercise of power by one part of society over another, he could not, or would not, see existing social arrangements as also embracing the exercise of power by men over women. In the case of Kay and Titmuss, this could be clearly seen on the domestic front as they engaged in ‘their tireless enactment of gendered ideology’. Her parents, Oakley suggests, were to collect ‘around themselves a coterie of people who shared their commitment to improving public and personal welfare through the analytic and prescriptive power of thought … Actually, he thought and discussed and she served the meals’.56 As an outsider, it is again difficult to know what to make of this. Oakley, of course, knew her parents in ways that nobody else could. However, whatever the particular dynamics of the Titmuss marriage, McKibbin, while acknowledging that society was dominated by men, nonetheless points to the complicated nature of gender relations in middle class households. In the search for ‘companionate marriage’ not only were men expected to perform at least some domestic tasks, it was also assumed that husband and wife would have ‘interests and friends in common’. Needless to say, this was not unproblematic. But, at the very least, it did suggest a not completely subordinate role for middle class women.57 Of course, none of this necessarily tells us much about the actual nature and texture of Titmuss and Kay’s relationship. But it is suggestive. So, for instance, while Titmuss may well have done little more around the house than wash the dishes, at least early on in their relationship he and Kay clearly had mutually enjoyable interests in common, such as hiking. Nor is it to reject wholesale the argument that Kay sacrificed her career to the project that was Richard Titmuss. Arguably, though, it was Kay who drove this project forward, albeit that Titmuss was undoubtedly ambitious in his own right.

Conclusion If the details of Titmuss’s early life are patchy, the broad outlines are clear enough. He grew up in modest, possibly very modest, but not impoverished, circumstances. He was educated at an institution which does not seem to have shone academically, but there is no reason to suppose that it was any worse than the many other private and preparatory schools then in existence, and which catered in the inter-​war era

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‘As the son of a farmer…’: origins, early employment, and personal life

for over a quarter of a million scholars.58 And, in any event, Titmuss’s poor health did little to enhance his educational experience.Titmuss’s first major employer, the County Fire Office, provided him with, if nothing else, financial security and a solid foundation in statistical analysis. He was clearly good at his job. So far, so relatively straightforward. We have an ambitious, talented, young man, keen, as we shall see in the next three chapters, to make an impact on inter-​war society, although at this point his future successes could hardly have been anticipated. In making his mark, and here matters become more complicated, he was supported and encouraged by Kay. But at what cost to her? Ultimately, this is an extremely difficult question to answer. For present purposes, what we can say is that her experience was hardly untypical, oppressive and constricting as we might now perceive it to be. Notes 1 M. Gowing, ‘Richard Morris Titmuss, 1907–​1973’, Proceedings of the British Academy, LXI, 1975, pp 3–​30. 2 ‘The Observer Profile: Welfare Professor’, The Observer, 22 March 1959, p 13. 3 G. Moorhouse, ‘The Poverty Lobby’, The Guardian, 3 December 1966, p 7. 4 LSE/​Staff Files/​Titmuss, R.M. Titmuss, ‘Application for the Chair of Social Administration’, undated but 1950. 5 COHEN, Box 235, folder 7, letter, 1 October 1973, Kay Titmuss to Eloise and Wilbur Cohen (emphasis in the original). 6 Oakley, Father and Daughter, pp 39–​40. 7 A.H. Halsey, ‘Richard Morris Titmuss’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 8 See, for instance, the description in Oakley, Man and Wife, pp 6–​7. 9 Gowing, ‘Richard Morris Titmuss’, p 30 (emphasis in the original). 10 LSE/​Staff Files/​Titmuss, letters, 27 July 1973, Gowing to Adams; and 23 and 24 July 1973, Adams to Gowing. 11 H. Glennerster, Richard Titmuss: Forty Years On: CASE/​180, Centre for Analysis of Social Exclusion, London, 2014, p 1. 12 For an account of Titmuss’s forebears, Oakley, Man and Wife, p 21ff. 13 W. Page (ed), The Victoria History of the County of Bedfordshire: Volume 2, London, Archibald Constable and Co, 1908, pp 348, 374. 14 Oakley, Man and Wife, p 27. 15 Gowing, ‘Richard Morris Titmuss’, p 3. 16 Oakley, Father and Daughter, pp 45–​6. 17 Gowing, ‘Richard Morris Titmuss’, pp 3–​4. 18 Oakley, Father and Daughter, p 51. 19 LSE/​Staff Files/​Titmuss, Allied Assurance Company Ltd:  Proposal for Life Assurance, 20 February 1958. 20 Oakley, Father and Daughter, p 52. 21 Oakley, Man and Wife, p 27. 22 The information here comes from the celebratory account, A.  Noakes, The County Fire Office, 1807–​1957, London, H.F. and G. Witherby, 1957, pp 3, 161,

31

RICHARD TITMUSS 163, 166; and from H.E. Raynes, A History of British Insurance, London, Pitman, 1948, pp 230–​32. 23 LSE/​Staff Files/​Titmuss, R.M. Titmuss, ‘Application for the Chair of Social Administration’, undated but 1950. 24 TITMUSS/​2/​140, cutting from the ‘Pendennis’ column, ‘Dark Corners in the Affluent Society’, The Observer, 1 April 1962, p 12. 25 Gowing, ‘Richard Morris Titmuss’, pp 3–​4. 26 Oakley, Father and Daughter, p 52. 27 R. McKibbin, Classes and Cultures:  England 1918–​1951, Oxford, Oxford University Press, 1998, Part II. 28 T. Porter, ‘Statistical Utopianism in an Age of Aristocratic Efficiency’, Osiris, 17, 2002, p 212. 29 CROSSMAN, MSS.154/​3/​TM/​7–​11, typescript of Crossman’s address at Titmuss’s Memorial Service, 6 June 1973, St Martins-​in-​the-​Field, London. 30 CROSSMAN, MSS.154/​3/​TM/​17, letter, 12 June 1973, Kay to Crossman. 31 Gowing, ‘Richard Morris Titmuss’, p 8. 32 Author interview with Frank Field MP, 5 November 2015. 33 Oakley, Father and Daughter, p 75. 34 Sheard, The Passionate Economist, p 280. 35 Gowing, ‘Richard Morris Titmuss’, p 4. 36 McKibbin, Classes and Cultures, pp 332–​9, 379. 37 Oakley, Man and Wife, pp 21, 31–​3, 44, 50–​52. 38 Gowing, ‘Richard Morris Titmuss’, p 5. 39 TITMUSS/​7/​2, typescript ‘Crime and Tragedy’, pp 9, 56. 40 Cited in Oakley, Man and Wife, pp 58–​9. 41 LSE/​Staff Files/​Titmuss, R.M. Titmuss, ‘Application for the Chair of Social Administration’, undated but 1950. 42 McKibbin, Classes and Cultures, p 87. 43 Oakley, Father and Daughter, pp 64–​5. 44 Oakley, Man and Wife, pp 49, 54. 45 Oakley, Father and Daughter, pp 63, 52ff. 46 Oakley, Man and Wife, pp 19, 37, 47. 47 Ibid, pp 3, 60–​61. 48 Gowing, ‘Richard Morris Titmuss’, p 5. 49 Oakley, Man and Wife, p 8. 50 LSE/​Staff Files/​Titmuss, letter, 9 June 1973, Kay to Adams. 51 Oakley, Father and Daughter, p 68. 52 Gowing, ‘Richard Morris Titmuss’, p 5. 53 H. McCarthy, ‘Social Science and Married Women’s Employment in Post-​War Britain’, Past and Present, 233, 1, 2016, pp 269, 277, and passim. 54 Oakley, Father and Daughter, p 56. 55 Oakley, Man and Wife, p 4. 56 Oakley, Father and Daughter, pp 8, 63 (emphasis in the original). 57 McKibbin, Classes and Cultures, pp 518–​20. 58 Ibid, p 237.

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3 Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March Introduction This chapter examines Titmuss’s political activism in the 1930s, a difficult decade for British society, and into the early part of the Second World War.Throughout the 1930s fear of another war was ever-​present, and the Depression after the 1929 crash further exacerbated socioeconomic disruption in the ‘traditional’ industrial areas. A  sense of foreboding was compounded by psychological ideas which stressed the irrational, unconscious, dimensions of human behaviour. For instance, the psychiatrist John Bowlby and the Labour politician Evan Durbin co-​authored a book entitled Personal Aggressiveness and War which discussed, among other things, what they described as ‘irrational acquisitiveness’.1 Titmuss and Bowlby were already acquainted by this point, and their paths were to cross on various occasions over the coming years. Both were to be signatories, for example, to a letter to the Prime Minister in 1965 on the extent of child poverty.2 Titmuss, too, was concerned with ‘acquisitiveness’, and saw psychological factors as contributing to international conflict. Gloom and doom, though, was not the whole story. Compared to continental Europe, Britain was politically stable, with the National Government, dominated by the Conservatives, elected in 1931, and returned to power in 1935. Some parts of the country, including London, saw the development of new industries, and new ways of living characterised by improved living standards leading to higher levels of home ownership, and the acquisition of new consumer goods.Yet this, in turn, highlights significant regional differences, and, overall, there was a highly charged political

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and cultural atmosphere. It was in this unsettling environment that Titmuss became politically active.

The Liberal Party and the Fleet Street Parliament In spring 1932 Titmuss was welcomed into Hendon Young Liberal Association by its honorary secretary, J.M. Henderson, who told him that Liberals were ‘few and far between in Hendon, but we are very keen’.3 This would appear to be the J.M. Henderson who, a few years later, was to become Titmuss’s literary agent, acting on behalf of the company Stephen Aske.4 Titmuss became an enthusiastic Liberal activist. In summer 1935, for instance, he sent a long piece to his local newspaper, outlining his views about the party’s current position. Titmuss conceded that many people could not remember living under a Liberal government and, since 1918, liberalism had been ‘fighting the reactionary movements engendered by the War’. The British people had ‘witnessed and endured the spectacle of two pitiful Labour Governments, both timorous, both fearful and both failing to fulfil their pledges’. These minority administrations had been in power in 1924 and 1929–​31 respectively, with the latter ultimately brought down by the economic catastrophe of 1929. The National Government had overseen an increase of those on poor relief, while ignoring evidence about distress among the unemployed. Demands for a foreign policy more attuned to the maintenance of peace had likewise gone unheard. The country did not want ‘Socialism’, but this would be forced upon it unless the Liberal Party could be revived. More positively, the latter endured because ‘it represents the English mind at its best’.5 The Liberal Party was undoubtedly struggling. Already in third place after the Conservatives and Labour, and badly divided, it had split further in the early 1930s when a group under Herbert Samuel had left the National Government. Membership was declining, in some areas local councillors were forming anti-​socialist alliances with Conservatives, and parliamentary representation was to be further reduced, to a mere 21 MPs, at the general election of November 1935.6 Undaunted, Titmuss did his bit. In the late 1960s he recalled being shouted down in the East End of London ‘when I tried to speak against the Mosley invasion’.7 This refers to Oswald Mosley and his Blackshirts, and suggests Titmuss’s presence at the so-​called Battle of Cable Street when the fascists were defeated in their attempt to stage an especially provocative march. If so, this was courageous, given the Blackshirts’ propensity to violence. A more congenial environment for political debate was provided by the Fleet Street Parliament, a debating society

34

Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

modelled on the House of Commons. It met at the St Bride’s Institute in Fleet Street, Central London. By 1935 Titmuss was being described as ‘The Leader of the Liberal Party’, and in this capacity he wrote to the Liberal MP for Middlesbrough, and Herbert Samuel supporter, ErnestYoung, about a debate the latter was to lead.Titmuss’s preference was that Young ‘attack the Socialists’ Programme.They are very strong in the [Fleet Street] Parliament and since last October we have had a succession of Bills nationalising the Banks, Industry, Transport and so on’.8Young duly spoke in favour of a motion denouncing the ‘principles and policy of the Socialist Party’ as ‘incompatible with the needs of a progressive nation’. If enacted, they would result in a ‘condition of reaction’ gravely prejudicial to ‘the best interests of the British people’.9 Titmuss clearly thought this event successful, telling a colleague that ‘Liberalism was very much alive and fighting last night’.10 Titmuss evidently thought little of the Labour Party.Although Labour had suffered a traumatic defeat in 1931, it had won control of the London County Council (LCC) in 1934. Under Herbert Morrison’s leadership, it was pursuing policies on matters such as healthcare which were, by contemporary standards, radical.11 Titmuss would have been well aware of such developments but, nonetheless, saw Labour as spineless, even reactionary, with only the Liberals offering a progressive alternative to the National Government.

International affairs: ‘Crime and Tragedy’ Titmuss’s political interests were not only domestic. As we saw in the previous chapter, he and Kay attended peace conferences in Geneva and Birmingham in 1936.The international situation, and the National Government’s handling of foreign affairs, were of considerable concern to those on the liberal and progressive left, who, consequently, tended to support the League of Nations. The League, based in Geneva, had been set up after the First World War as an intergovernmental body aimed at resolving international disputes on a peaceful, cooperative, basis. It sought to prevent the sort of misunderstandings, and military alliances, which, it was widely believed, had resulted in the immensely destructive conflict which had broken out in 1914. By the mid-​1930s, however, the League had suffered a number of blows. For example, the US had always stood apart, and shortly after coming to power the Nazi regime in Germany had quit. British supporters of the League were organised in the League of Nations Union, one of a number of bodies seeking stable and peaceful international relations. It conducted the so-​called ‘Peace Ballot’, the result of which was announced in July

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1935.This showed overwhelming support for, among other things, the use of economic sanctions by League members against any country pursuing an aggressive foreign policy, and continuing British membership of the League.12 Another organisation concerned with peaceful international relations, the Council for Action for Peace and Reconstruction, was set up in July 1935 at a convention held at London’s Caxton Hall. The driving force here was former Liberal leader and Prime Minister, David Lloyd George, and the founding meeting attracted over 2,500 delegates, including 82 MPs. Addressing the meeting on its first day, Lord Cecil of Chelwood, a leading figure in the creation of the League of Nations, told delegates that the ‘Abyssinian question’ –​Abyssinia is now called Ethiopia –​‘was the most serious foreign complication … since the War’. The convention’s resolution supporting all moves towards a peaceful resolution of international disputes therefore had a particular sense of urgency.13 The following day Lloyd George, in what The Times described as his ‘Call to Arms’, proposed that efforts should be made to secure the return of MPs, irrespective of party affiliation, who supported the Council’s aims. He also suggested that the current international situation was worse than that of 1914 while, on the domestic front, there was an urgent need to tackle unemployment.14 Titmuss attended the Caxton Hall meeting, writing in its aftermath to the Council’s organising secretary. A special meeting of the Fleet Street Parliamentary Liberal Party had been held, had unanimously endorsed ‘the resolutions adopted by the Council of Action … in regard to Peace and Reconstruction’, and had pledged itself to ‘support the proposals and policy’ outlined in the manifesto issued by the council.15 Shortly afterwards, in the St Bride’s Institute’s journal The Bridean, Titmuss argued that the Liberal Party’s role was to ‘fight to lift from the hearts of the people the dread of war, and from their homes the anxiety and misery of want and destitution’.16 But soon after Titmuss’s article appeared, the Abyssinian situation took a further turn for the worse when that country was invaded by Italy, notwithstanding that both countries were League of Nations members. These events were blows from which the organisation did not recover. The European situation was to continue to deteriorate with, over the coming few years, the outbreak of the Spanish Civil War, and the consequences of the already aggressive foreign policy of Nazi Germany. Titmuss was alive to these issues. In a further piece for The Bridean, in 1936, he wrote that Europe was ‘rattling back to barbarism’. So the ‘problem of organising peace is now –​more than ever –​of paramount

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Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

importance. It is, in fact, the condition of survival’. The Fleet Street Parliament’s Liberals, were, therefore, ‘fully prepared to subordinate all party interests to supporting with all our energies’ any policy, whoever proposed it, which sought to rebuild and strengthen the League of Nations, and to organise ‘a worldwide non aggression, arbitration and mutual assistance treaty’ based on the League’s covenant, and open to all countries. A treaty of this sort, effectively an ‘International Popular Front’, would bring diplomatic, security, and economic benefits to all participants. Such a plan offered the British people, confronted by an ‘anarchic world’, the ‘only chance of removing the danger of another European conflagration’. War would not be avoided, on the other hand, by ‘an armaments race, isolation or negative pacifism’.17 Titmuss had clearly been impressed by the French and Spanish Popular Fronts, seeing them as a model for cross-​party cooperation on an international scale. Calls for a British Popular Front were not confined to the Labour and Communist parties. There were those within the Liberal Party who advocated political alliances to combat fascism and appeasement. Titmuss was, as we shall see, close to one of the most fervent Liberal advocates of this position, Richard Acland, and his own pronouncements put him likewise in this camp.18 Titmuss’s rejection of ‘negative pacifism’ is similarly a rebuke to those, not a few in the 1930s, who argued that pacifism was, by itself, an acceptable moral, and political, position. A few months later an official of the National Peace Council congratulated Titmuss on the setting up of a ‘Youth Peace Council’.19 It would be stretching the point to describe Titmuss as a ‘youth’ by this time, but this does, once more, illustrate his commitment to issues about which he felt strongly.These included the current state of British society, and, especially urgent as the 1930s drew to a close, the international situation. For those such as Titmuss these were not separate matters, but interlinked. Support for rearmament, and growing opposition to the appeasement of dictatorships, by both the Liberal and the Labour parties, have to be seen as part of a broader condemnation of a social order lacking in principles, unthinkingly devoted to free-​ market capitalism, and prepared to neglect or obfuscate problems both at home and abroad. As David Edgerton points out, it was liberal and socialist internationalists who were, in reality, most alert to the threat of, especially, Nazism, rather than the supposed pragmatists engaging in appeasement.20 Titmuss’s concerns about international politics were forcefully articulated in his unpublished mid-​1930s book ‘Crime and Tragedy’

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(alternative titles: ‘Government by Betrayal’ and ‘Creation of Anarchy’). It dealt with the culpability, as Titmuss saw it, of the National Government for the state of international affairs. This was an angry text, dedicated to ‘Those Who Laid Down Their Lives That Others Might Uphold the Divine Right to Use Bombing Planes’. Titmuss praised those, including Lord Cecil, ‘who have worked unremittingly for the strengthening of World Government’. His book sought to show how ‘the Government by their supine handling of Foreign Policy since 1931’ had ‘allowed the Nation to drift far along the path that leads inexorably to international insanity’.While Britain was not solely responsible for the deteriorating situation, nonetheless, given the country’s world role, it was ‘chiefly to blame’. Discussing the constructive ends to which the League of Nations might be employed, Titmuss melodramatically suggested that it was ‘for this belief and a passionate conviction in the power of the British Empire to lead the Nations towards the banishment of anarchy from the earth that I am prepared to lay down my life’.21 Titmuss then cited numerous examples of Britain’s failure to support the League, for instance over Abyssinia. This had resulted in messages from across the world expressing ‘astonishment at the part played by the British Government in a shameless and callous betrayal of the League’. The ‘name of England, and all that it means to us’ was thus ‘splashed with mud and abuse from every corner of the globe’. Britain’s actions were a betrayal of those, suffering under oppression and dictatorship, who had looked to it for hope. Equally betrayed had been those who thought the League of Nations ‘the one good thing born of 1918’, and who remembered ‘our glorious heritage of freedom and democracy’. Again showing a talent for melodrama,Titmuss then suggested that ‘Generations unborn will rise one day and curse these flag-​bedecked Conservative leaders’ for seeking to reward aggression, and their failure to exert British leadership.The Abyssinian and other foreign policy setbacks were unreservedly attributed to the National Government. Conservatism refused ‘to allow Great Britain to take its rightful place at Geneva. We must not take the initiative’. Its ‘creed’ asserted that Britain ‘must be one of a crowd in the League.We must be indistinguishable in the comity of nations [and so] must not take one step in advance of the most turbulent and backward South American or Balkan State’. Consequently, disarmament talks had gone nowhere (hence, in part, the rise of Hitler), and British society itself was, as fears of war grew, becoming militarised. Such fears had ‘spread over the country like a noisome cloud of poison gas’, and were being used to suppress protest.22

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Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

A further impact of the National Government’s approach to foreign policy could be seen in its dealings with the empire. In 1932 the Ottawa Conference, responding to the 1929 economic crisis, had set up a tariff system whereby the British economy was ‘protected’ by a series of barriers to foreign imports, while also setting up purportedly favourable arrangements with the British Dominions –​‘imperial preference’. But this did not result in a form of ‘empire free trade’. Leaders of the Dominions also sought to protect their own economies. More broadly, this was an important step in ending Britain’s historic, if by now somewhat tattered, commitment to international free trade. For Titmuss this was highly unwelcome. The conference had allowed the ‘appearance of economic nationalism in some of its worst aspects’, and had had a disruptive effect on the global economy. Because of the horse-​trading over preferences between Britain and the Dominions, furthermore, the National Government had come ‘nearer than any previous administration has ever done to shattering the British Empire into small pieces’. Outside the empire, British policy was, on the one hand, to advocate collective security (whether it actually did anything about this was another matter, at least by Titmuss’s account in the rest of his book), while simultaneously supporting ‘economic policies which can only lead to impoverishment and unemployment in Europe, to the spread of hunger and fear, and to the rise of despotic governments with huge armaments and supported by neurotic and desperate peoples’. At Ottawa the British government had ‘presented to the world an imperialistic example of naked uneconomic [sic] nationalism. Mussolini and Hitler soaked it all in’.23 Titmuss’s political concerns were, in the 1930s, as much with the international as with the domestic situation. He was clearly incensed at what he saw as the betrayal of the League of Nations, and British foreign policy’s ‘supine’ role. He actively engaged with these issues through participation in meetings, his leadership role in the Fleet Street Parliament, and his writings. His unpublished ‘Crime and Tragedy’ is notably intemperate in its language, especially when it came to the Conservative Party. Perhaps more surprisingly,Titmuss also saw a leadership role in world affairs for both Britain and the British Empire. His positive view of the empire was not especially unusual at the time as it could be seen, and perhaps Titmuss saw it this way, as a form of international cooperation which, at least on some levels, seemed to work. It is equally notable that, in the context of the empire and more broadly, he was hostile to economic protectionism, a classic Liberal Party position. For liberal thinkers such as Titmuss, free trade was crucial in combatting nationalism and militarism.

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Liberal Summer School In 1938 Titmuss attended the Liberal Summer School held in Oxford, although he did not contribute to it formally.24 The following year, though, he was on the platform in Cambridge. Writing shortly after Titmuss’s death, the historian Keith Hancock, from the early 1940s an important figure in his life, claimed that Titmuss had been persuaded to attend by some ‘young Liberals who belonged to his suburban cricket team’.25 In fact,Titmuss was suggested to the General Secretary of the Liberal Summer Schools, Sydney Brown, by the broadcaster F. Buckley Hargreaves. Hargreaves had passed on to Brown the view of the King’s physician, Lord Horder, that Titmuss’s first book, Poverty and Population, was ‘the best of its kind he has ever come across’.26 Horder had provided the foreword for this volume, discussed in the next chapter, and it supplied much of the material for his Cambridge address. Also speaking that morning was the leading businessman, authority on population issues, and Eugenics Society stalwart, Laurence J. Cadbury, whom Titmuss almost certainly knew. Cadbury spoke on ‘A Population Policy and Family Allowances’, an issue with which he was becoming increasingly concerned to the extent that he actually granted them to his own employees.27 Prior to the event, Titmuss contacted Cadbury suggesting they compare notes in order to avoid any duplication of content. He also told him that he intended to carry on where the Oxford economist Roy Harrod had left off at the Oxford Summer School, remarking that Harrod’s paper was in his view ‘rather sensational’. Although Titmuss did not elaborate on what he meant here, in Poverty and Population he had upbraided Harrod for indulging in ‘alarming prophecies’.28 As we shall later see, this was, at least as far as population was concerned, a bit rich coming from Titmuss. Titmuss’s talk, ‘Contemporary Poverty, Regional Distribution and Social Consequences’, was very much in line with his current preoccupations, also discussed in more detail in the next chapter. He started with information on the ‘geographical incidence of such accompaniments of poverty as severe infantile mortality’. Arguing that there was ‘no biological reason’ why the infant mortality rate could not be reduced to 30 per 1,000 throughout the whole country (the national average at this point was 58), he then pointed to huge discrepancies between, for example, the Home Counties and Wales. He also compared English urban areas, unfavourably, with foreign cities such as Amsterdam.Titmuss then went on to attack the government’s ‘wishful thinking’ over the fitness of army recruits. In so doing, officials and politicians were consciously rejecting the work of researchers such as

40

Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

the nutritionist John Boyd Orr.29 His speech seems to have been well received. Sydney Brown told him that after ‘the ovation the School gave you yesterday you don’t need any word of mine to tell you how very much your address was appreciated’. It was, moreover, ‘excellent that our final session should deal with constructive policy after the rather grim week we have had’.30 Given that the Summer School took place shortly before the outbreak of war, there can be little doubt as to what her concluding remark refers. Titmuss was also contacted by Gerald Barry, managing editor of the leading Liberal newspaper News Chronicle, asking for two articles based on his talk (it probably helped that Cadbury chaired the paper’s board). These Titmuss duly delivered to his literary agent, Henderson, a few days later.31 More broadly,Titmuss’s Cambridge speech had been given alongside those of leading Liberal figures such as Lord Samuel, surely a sign of his growing status as a polemical commentator on current affairs. As Michael Freeden points out, this particular Summer School marked a positive step on the Liberal Party’s part to promoting the idea of family allowances, both to alleviate family poverty and to address fears about a declining population, issues with which Titmuss was deeply engaged. As such, family allowances constituted an appeal to ‘progressive opinion’ at a time when the labour movement remained divided about the issue, although Freeden rightly suggests that the ‘insecurity and fears generated by the international crisis’, rather than committed plans for social reform, profoundly shaped the mainstream Liberal agenda.32 Nonetheless the appeal of liberalism for Titmuss, and of Titmuss for liberalism, is apparent. Titmuss’s support for ‘progressive opinion’ was also manifested in, for example, the invitation he received to join the National Council for Civil Liberties (NCCL) from its founder, Ronald Kidd. Kidd informed Titmuss that he had been given his name by Ursula GrantDuff, Eugenics Society stalwart and supporter of the Titmuss family. In response,Titmuss enclosed his subscription, telling Kidd that, as ‘an author and writer on social questions’, the NCCL was carrying out work of ‘great importance’, and he wished him well in his membership drive.33 This correspondence took place just after the outbreak of war, when civil liberties were, for bodies like the NCCL, under threat. On Titmuss’s part, it should therefore be seen as a statement of his position, and in line with his objections to what he saw as unacceptable treatment of refugees, noted further in the next chapter. In the years before the outbreak of war, Titmuss was politically active on a range of fronts, all underpinned by his commitment to the Liberal Party.

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Forward March The coming of the Second World War saw, as Ross McKibbin puts it, the pre-​war party system ‘Thrown Off Course’. While before 1939 the Conservative Party had established ‘a political supremacy which seemed unchallengeable’, soon the demands of ‘total war’ led to the creation of the wartime coalition government.This was led by Winston Churchill, a Conservative, but also included leading figures from other parties, for instance, as Deputy Prime Minister, Labour leader Clement Attlee.An electoral truce whereby, in the event of by-​elections, no rival candidates were put up to those of the incumbent party more or less held throughout the war. The end of fighting in Europe saw the first general election in ten years, and the unexpected landslide victory of the Labour Party. During the conflict itself, post-​war social reconstruction became a prominent theme in domestic politics once the various severe crises of the early years had abated.34 In short, the political landscape fundamentally changed between 1939 and 1945. It is therefore appropriate at this point to discuss Titmuss’s involvement with Forward March, one of the predecessors of the better known Common Wealth Party.Although this discussion extends slightly beyond the notional end of this part of the book (1941),Titmuss’s engagement had its origins in his earlier participation in Liberal politics. Titmuss had strong, rather unconventional, views about the political situation in the early part of the conflict, views which he was happy to broadcast. Common Wealth was founded in July 1942 by a merger of the writer J.B. Priestley’s 1941 Committee, and Sir Richard Acland’s organisation, Forward March. It was to go on to win a number of by-​elections, in defiance of the wartime electoral truce. The organisation’s principal slogans were ‘Common Ownership’,‘Vital Democracy’, and ‘Morality in Politics’, alongside the demand that the Beveridge Report be implemented in full, and immediately.35 The key figure in Common Wealth was the eccentric former Liberal MP, Acland, encountered earlier as a supporter of a Popular Front. Titmuss was active in the various factions which were to become Common Wealth, an organisation which, Acland’s biographer suggests, appealed ‘essentially to the more modest, professional middle classes, notably in London and on Merseyside’.36 This no doubt applied to its predecessors, and accurately enough describes Titmuss.Acland and Titmuss had been in touch since at least late 1938 when they had entered into a correspondence over one of Titmuss’s obsessions of the time, population health.Titmuss had also been among those who, having been sent a copy by the author, had responded to Acland’s 1940 Penguin best-​seller Unser Kampf (Our

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Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

Struggle, an allusion to Hitler’s Mein Kampf). This was part of Acland’s strategy to form a broad, progressive political front looking forward to post-​war social reconstruction. Titmuss told Acland that while ‘as a Liberal’ he might disagree on ‘a few side issues’, nonetheless he accepted ‘your major argument for Common Ownership with all that implies in national and international relations’. If a majority of the ‘Liberals and Labour accept your case’, then the ‘Lib-​Lab front on Common Ownership must become a reality’.37 Acland’s response also contained an invitation to a Forward March meeting to be held at the Commons in early March 1940. Titmuss accepted, adding that in his view ‘the most important and urgent step’ would be to ‘break the political truce’. This meant, he argued, ‘continuous pressure’ on the Labour Party and the Trades Union Congress, and required the formation of an ‘ALL-​ PARTY COMMITTEE’.38 An ‘Unser Kampf ’ group (presumably an alternative name for Forward March) was formed, and in spring 1940 issued a ‘Manifesto of the Common Men’. This sought to ‘build a new world based on a new morality. To put into practice in our public life the principles which we pay lip service to in our churches’, and it was to such ends that ‘we invite the co-​operation of our fellow-​men’.Titmuss, describing himself as a ‘Writer and Statistician’, agreed to be a signatory to this document.39 A few weeks later, he became chairman of the group’s Home Policy Committee, and, as such, party to a discussion which noted that the government now had complete power over both capital and labour, something which could be used for either progressive or reactionary ends. There was no effective parliamentary opposition, so wartime policies should focus on ‘new moral imperatives’ –​again a very Titmuss notion –​such as the ‘permanent conscription of capital’ and ‘workers representation’.40 During Acland’s brief spell in the army, Titmuss once more took a leadership role, telling a correspondent that he ‘personally felt that the work should go on and that some direction was needed in Acland’s absence.41 He also seems to have been a member of Forward March’s ‘Inner Executive’, a small body of five individuals which included Acland and Titmuss’s friend, François Lafitte.42 Further reinforcing this idea of Titmuss in a leadership role, by spring of 1941 he was, apparently, chair of the Unser Kampf group, and consequently dealing with various enquiries to the organisation. For instance, he responded to a correspondent who had approached Unser Kampf with what appears to have been proposals based on the idea of Social Credit. The latter argued for the establishment of a form of economic democracy, particularly by way of monetary reform. In reply, Titmuss suggested that while he agreed that much was wrong with the

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present monetary system, nonetheless it would be mistaken to think that ‘drastic change in the monetary system and its operation would create –​by itself –​a new kind of society’. The system was ‘part and parcel of an acutely acquisitive society’ and Unser Kampf had recently publicised what it saw as the consequences of such ‘acquisitiveness … as it impinges on our war effort’.43 The phrase ‘acquisitive society’ alludes to the work of the ethical socialist, R.H.Tawney, a recurring figure in this volume. Titmuss also gave talks on behalf of Forward March, for example to the latter’s Ealing Group in May 1942 on ‘Private Profit versus the Health Subsistence and Conservation of the People’.44 There can be little doubt that Titmuss played an important role in Forward March. In summer 1941, Acland told him that he felt something important was about to happen and, although he did not specify what, perhaps he, like Titmuss, saw the evacuation from Dunkirk the previous year, and the subsequent Blitz, as transformative moments in British history. In any event, something prompted him to reflect on Forward March’s own recent history. Reviewing the last 15 months, Acland gratefully acknowledged all the people who had helped the organisation. But, he continued, ‘I look back also on that meeting we had outside the dining room of the House of Commons when you and I tried to think up in a hurry one or two practical conclusions to which we hoped that first meeting might perhaps lead’.This was clearly the meeting to which Titmuss had been invited in March 1940. ‘Since then’, Acland flatteringly suggested, ‘you and only you have remained with us quite steadily in good times and bad’. Throughout, Titmuss had given ‘the wisest advice’, and whenever he had agreed to do something it had happened. As things presently stood, it was ‘quite clear to me that the next stages of our enterprise could not be accomplished without your steady guidance and advice almost from day to day’.45 In reply, Titmuss told Acland that he would continue to do what he could before going on to make an important statement of his own beliefs. Looking back to the era of the Popular Front, that is the mid-​1930s, he could see that ‘what counted most with me at the very beginning was sincerity in public life’. And, as he began to ‘think more deeply’, there came the ‘importance of ideas; moral values’. Equally importantly, there must be ‘no compromise’. Although not a Christian himself, he was perhaps appealing to Acland’s Christian socialism when he suggested that while ‘Christ would not admit hairsplitting’, nonetheless ‘one outstanding feature of our time is the ability of the progressive to hairsplit’. Perhaps this was because progressives symbolised ‘the age of indecision from which I hope we are now emerging’. In his own work, meanwhile, he was hoping soon to complete ‘my study of

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Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

Infant Mortality and Social Class’ –​what was to be Birth, Poverty and Wealth. His text had been vetted by ‘other experts’, and showed conclusively that the working class, and the poor, were now worse off in relative terms than before the First World War. Clarifying his point, he continued that this was ‘in terms of health, which incidentally should be the criterion of any new order.The fact that no one has previously studied the subject indicates that in an acquisitive society even research concentrates on money tokens –​not health’.46

Titmuss’s liberalism Unfortunately, at least for Acland,Titmuss was unable to fulfil the role the former had envisaged for him, although the two kept in touch. Titmuss also compiled a file about Common Wealth, including a draft response to the Beveridge Report written by Lafitte.Years later, he was to send this to Abel-​Smith, describing it as a ‘fragment of history’.47 The Beveridge Report, published in 1942, was not the revolutionary work sometimes claimed (including by its author). Essentially, it proposed rationalising and expanding existing social insurance schemes, while making, admittedly important, arguments for healthcare reform, family allowances, and the maintenance of full employment. Sir William’s proposals caught the popular mood, though, appearing at a point when there were growing expectations that the war would be won, with social reconstruction to follow. In time, Titmuss became highly critical of Beveridge. But, like many others, he was thrilled by the report’s appearance. A quarter of a century later, he recalled ‘the excitement I and my friends felt’ on first reading it. Despite the stresses of the war’s early years,‘we still believed as democrats that we could change society; that we could build a better world for all including the poor’. They thought, too, that with ‘hard work, responsibility and imagination’ they could bring about the end of the ‘hated stigma of the poor law means test’, and the associated view that anyone ‘dependent on the State for income maintenance and public services’ should be regarded as inferior, a ‘second class citizen, and … social failure’.48 But to return to Common Wealth, by late 1941 Titmuss had begun researching what was to become Problems of Social Policy. As he informed Acland in summer 1942, because of this work for the Cabinet Office he could not be so publicly active on Forward March’s behalf. But as he also told Acland, his attitudes had not changed.49 How, then, does this fit with the correspondence between Titmuss and Kingsley Martin, editor of New Statesman, where the former claimed that he had moved over to socialism, albeit a socialism which,

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in an important qualification, ‘derives from a moral not an economic impetus’?50 This is, therefore, an appropriate point to discuss Titmuss’s political engagement from the mid-​1930s to the early 1940s, and the insights it affords to his thinking. First, Titmuss threw himself wholeheartedly into Liberal, and more broadly progressive, political activity. He took on a leadership role at a time when he had a full-​time job, and when, as we shall see in subsequent chapters, he was also carrying out research, engaged with organisations such as the Eugenics Society, and promoting his ideas to an ever wider audience. Demanding as his political activities were, they were crucial in honing his speaking, writing, and organisational skills, put to good effect in the rest of his career. It is also striking how he saw himself. He was, by his own account, an ‘author and writer on social questions’, a ‘writer and a statistician’, someone whose work had been scrutinised by ‘other experts’. And his various activities were sufficiently well known for him to appear as an invited speaker at the Liberal Summer School in Cambridge. Second, we must ask what kind of liberal Titmuss was, in the sense of the ideas he held. Freeden identifies what he calls a left-​liberalism in this period, with its ongoing adherence to ‘ethical liberalism’. This embraced a ‘communitarian ethic’, and continued to base its social analysis on an ‘organic holism’. Such ‘organic holism’, in turn, pervaded its ‘assessment of social structure and function’.There is much here which fits with what we have so far noted of Titmuss’s ideas. For instance, his acceptance of Acland’s plans for ‘Common Ownership’ indicate a commitment to a communitarian ethic. Perhaps most revealingly, though, is Titmuss’s use of the expression ‘acquisitive society’. This phrase derived from the title of a book by R.H.Tawney, whom Titmuss much admired and who, as Freeden remarks, appealed to those who were on the left-​wing end of the liberal spectrum.51 But for present purposes, for its critics an ‘acquisitive society’ was one where materialism –​the ‘money tokens’ Titmuss wrote about to Acland –​rather than morality predominated, to the detriment of both individuals and the wider social sphere. Titmuss advocated, as an alternative, a society which recognised human interconnectedness, so encouraging altruism to operate. This would bring out the best in individuals, to their own and society’s benefit. Hence the importance he attached to ‘moral values’ when recollecting the formation of his own thought at the time of the Popular Front. Third, Titmuss could be somewhat contradictory. He deprecated compromise and ‘hairsplitting’, and his early reaction to the Labour Party was one of undisguised hostility. He likewise opposed the wartime electoral truce. He was, however, keen on cross-​party collaboration,

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Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March

and by the early part of the war was advocating a ‘Lib-​Lab front on Common Ownership’. This was some way from his earlier condemnation of Labour and, notably, its plans for nationalisation. Britain’s domestic wartime experience, and Titmuss’s perceptions of it, undoubtedly shifted his views towards more collectivist solutions to social problems. So perhaps by the early 1940s Titmuss was, consciously or otherwise, beginning to move his political allegiance, at least in party terms, from Liberal to Labour. But when we come to assess Titmuss’s life and work, it will be argued that in certain respects he remained true to a version of Edwardian progressivism, as espoused by the New Liberals prior to 1914. Finally, for Titmuss, as for his colleagues on the liberal left, the 1930s was a grim decade.The collapse of the international order, the National Government’s use of protectionist economic measures, and the descent into war were indicators of the ‘anarchic world’ condemned by Titmuss. Hence, as the Manifesto for the Common Men had stated, the need to ‘build a new world based on a new morality’. On the domestic front there had to be, as Titmuss put it, a ‘new kind of society’. An essential plank in this new society was health, the ‘criterion of any new order’ (an unfortunate phrase, given its adoption by the Nazi regime). In part, what was required was social intervention to address poor health outcomes. But ‘health’ also had a broader meaning, one which had been developed in Edwardian progressivism, namely the active promotion of wellbeing at both individual and social levels. Freeden suggests that this was, ultimately, to mutate into ‘welfare’, and was in accord with organic views of society such as those held by Titmuss.52 It is notable, too, that in the 1930s some on the political left were developing the notion of a ‘right’ to health, the latter to embrace not only curative, but also preventive, medicine. In certain instances, this was underpinned by explicitly organic reasoning.53 As we shall see in Chapter 9,Titmuss was to be central to the emergence of social medicine, which sought to see beyond the clinical dimensions of ill health to their socioeconomic context.

Conclusion The 1930s had a profound impact on Titmuss. He was engaged politically through activism on behalf of the Liberal Party, activism which embraced both domestic and international politics. In both areas he forcefully criticised the National Government, sometimes in highly charged language. When war came, Titmuss remained politically committed, working closely with Acland on Forward March, although

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by this time it is possible to discern a shift away from the Liberal Party, if not liberalism.As we shall see in Chapter 6, his perceptions of the 1930s and the early years of the Second World War were to shape his analysis of wartime Britain on the Home Front which, in turn, reinforced his demands for wholesale social reconstruction once the conflict was over. Before that, though, we turn in the next two chapters to some of Titmuss’s other activities in the 1930s and early 1940s, which again focus on his commitment to his version of ‘progressive’ politics. Notes 1 E.F.M. Durbin and J. Bowlby, Personal Aggressiveness and War, London, Kegan Paul, Trench and Trubner, 1939, p 126 and passim. 2 TITMUSS/​2/​214, letter, 22 December 1965, Child Poverty Action Group to Harold Wilson. 3 TITMUSS/​8/​1, letter, 13 May 1932, Henderson to RMT. 4 Oakley, Man and Wife, p 65. 5 TITMUSS/​8 /​2 , draft letter, 27 July 1935, RMT to editor, Hendon and Finchley Times. 6 D. Dutton, A History of the Liberal Party since 1900, London, Palgrave Macmillan, 2nd edn 2013, Ch 3 and Appendix 1. 7 TITMUSS/​8/​14, letter, 30 April 1969, RMT to Robin Blackburn; also Oakley, Father and Daughter, p 191. 8 TITMUSS/​8/​1, letter, 16 January 1935, RMT to Young. 9 TITMUSS/​8 /​1 , ‘Notice of Meeting of Fleet Street Parliament, 11 th February 1935’. 10 TITMUSS/​8/​1, letter, 12 February 1935, RMT to Miss W.  Reeve, National League of Young Liberals. 11 J. Stewart,‘ “The Finest Municipal Hospital Service in the World”? Contemporary Perceptions of the London County Council’s Hospital Provision, 1929–​1939’, Urban History, 32, 2, 2005, pp 327–​44. 12 D.Todman, Britain’s War: Into Battle, 1937–​1941, London,Allen Lane, 2016, pp 61ff. 13 ‘The “Call to Action” ’, The Times, 2 July 1935, p 18. 14 ‘The “Council of Action”: Mr Lloyd George’s Call to Arms’, The Times, 3 July 1935, p 9. 15 TITMUSS/​8/​1, letter, 23 July 1935, RMT to Organising Secretary. 16 TITMUSS/​8/​1, clipping from The Brideian, September 1935, R.M.Titmuss,‘The Liberal “Attack” ’, p 5. 17 TITMUSS/​8/​1, clipping from The Brideian, September 1936, R.M.Titmuss,‘The Liberal Party’, p 9. 18 M. Pugh, ‘The Liberal Party and the Popular Front’, English Historical Review, CXXI, 494, 2006, pp 1327–​50. 19 TITMUSS/​8/​2, letter, 10 December 1936, National Organiser to RMT. 20 D. Edgerton, The Rise and Fall of the British Nation: A Twentieth Century History, London, Allen Lane, 2018, p 61. 21 TITMUSS/​7/​2, typescript, ca 120 pages, ‘Crime and Tragedy’, pp 2, 4, 5, 9. 22 Ibid, pp 56, 71, 96–​7. 23 Ibid, pp 42–​4.

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Politics: the Liberal Party, the ‘Fleet Street Parliament’, and Forward March 24 TITMUSS/​8/​4, Brochure for Liberal Summer School, Randolph Hotel, Oxford, July/​August  1938. 25 Letter, Sir K. Hancock, ‘Richard Titmuss’, The Times, 15 May 1973, p 18. 26 TITMUSS/​8/​4, letter, 27 February 1939, Hargreaves to RMT. 27 TITMUSS/​8/​4, Brochure for Liberal Summer School, University Arms Hotel, Cambridge, August 1939, p 19. On Cadbury and family allowances, see R.A. Soloway, Demography and Degeneration:  Eugenics and the Declining Birthrate in Twentieth Century Britain, Chapel Hill, University of North Carolina Press, 1990, p 306. 28 TITMUSS/​8/​4, letter, 18 June 1939, RMT to Cadbury; R.M.Titmuss, Poverty and Population: A Factual Study of Contemporary Waste, London, Macmillan, 1938, p 33. 29 ‘Liberal Summer School: Family Allowances to be an Issue at the Next Election’, The Manchester Guardian, 10 August 1939, p 15. The infant mortality rate is the number of deaths of infants under one year of age per 1,000 live births. 30 TITMUSS/​8/​4, letter, 10 August 1939, Brown to RMT. 31 TITMUSS/​7/​47, letters, 11 August 1939, Barry to RMT; and 16 August 1939, RMT to Henderson. 32 M. Freeden, Liberalism Divided: A Study in British Political Though, 1914–​1939, Oxford, Oxford University Press, 1986, p 344. 33 TITMUSS/​7/​47, letters, 22 November 1939, Kidd to RMT; and 29 November 1939, RMT to Kidd. 34 R. McKibbin, Parties and People: England 1914–​1951, Oxford, Oxford University Press, 2010, Ch 4. 35 P. Addison, The People’s War:  Britain 1939–​1945, London, Pimlico edn, 1992, p 546ff. 36 A.F.Thompson, ‘Sir Richard Thomas Dyke Acland’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 37 TITMUSS/​8/​6, letter, 17 February 1940, RMT to Acland (emphasis in the original). 38 TITMUSS/​8/​5, letters, 19 February 1940, Acland to RMT; and 1 March 1940, RMT to Acland (emphasis in the original). 39 TITMUSS/​8/​5, letter, 19 March 1940, RMT to Secretary, ‘Manifesto of the Common Men’; and Notice of Meeting of the Unser Kampf Group, 26 March 1940. 40 TITMUSS/​8/​6, ‘Home Policy Committee: Resume of Discussions 31st May, 1940’, p 1 and signed by RMT. 41 TITMUSS/​8/​6, letter, 4 March 1941, RMT to Kenneth Ingram. 42 TITMUSS/​8/​5, ‘Unapproved Minutes of a Meeting of the Inner Executive of the Forward March Held … on Thursday 2nd April at 7pm’. No year but Kay Titmuss has written 1941?, which looks right. 43 TITMUSS/​8/​6, letter, 5 April 1941, to W.F. Kissack. 44 TITMUSS/​8/​6, letter, 21 April 1942, Wilfred Brown to RMT. 45 TITMUSS/​8/​7, letter, 4 June 1941, Acland to RMT. 46 TITMUSS/​8/​7, letter, 21t June 1941, RMT to Acland (emphasis in the original). 47 TITMUSS/​2/​83, typescript ‘Statement to Branches on the Beveridge Report’ with attached note, 28 November 1955, RMT to Abel-​Smith. 48 R.M. Titmuss, ‘The Right to Social Security’, in R.M. Titmuss and M. Zander, Unequal Rights, London, CPAG, 1968, p 3. 49 TITMUSS/​8/​6, letter, 5 June 1942, RMT to Acland.

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RICHARD TITMUSS 50 Cited in A.H. Halsey, No Discouragement: An Autobiography, Basingstoke, Macmillan, 1996, p 217. 51 Freeden, Liberalism Divided, pp 223ff., 313ff. 52 M. Freeden, Liberal Languages:  Ideological Imaginations and Twentieth Century Progressive Thought, Princeton NJ, Princeton University Press, 2005, pp 175–​7,  182–​4. 53 J. Stewart,‘ “Man against Disease”: The Medical Left and the Lessons of Science’, in D.  Leggett and C.  Sleigh (eds), Scientific Governance in Britain, 1914–​79, Manchester, Manchester University Press, 2016, pp 199–​216.

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4 The Eugenics Society, Poverty and Population, and ‘Manpower and Health’ Introduction The last chapter examined Titmuss’s political activities in the 1930s and early 1940s. Demanding as these undoubtedly were, Titmuss also found time for other forms of social and political engagement. Among his early research interests were population, and population health. He was convinced, as were many others at this time, that Britain’s population was in decline, and that this promised problems for the future. Nonetheless, as Pat Thane puts it, Titmuss was ‘the most persistent, prolific, and one of the most immoderate demographic pessimists’ of the 1930s and beyond.1 We shall encounter this pessimism in this, and later, chapters. Titmuss was, further, concerned about population health, arguing that proper analysis of the rates of morbidity and mortality revealed significant class and regional disparities in health experience and outcomes. Such concerns led to membership of the Eugenics Society, his first major publication, and conclusions with serious implications, at least in his view, for Britain’s preparedness for what was, by the late 1930s, inevitable war.

The Eugenics Society The Eugenics Society (originally the Eugenics Education Society) was founded in 1907. It was a small but influential body campaigning for greater attention to be paid to issues of heredity and population quality. Among its members in the 1930s and 1940s were William Beveridge, and his successor as LSE director from 1937, the social scientist

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Alexander Carr-​Saunders. Titmuss was introduced to the society in 1937 by the LSE demographer and refugee from Nazi Germany Robert René Kuczynski, remaining a member until shortly before his death. Kuczynski, who had published alarming predictions about population decline in Western Europe, had favourably noted Titmuss’s statistical skills. Titmuss gained further kudos with the Society when, a year later, he published Poverty and Population, which impressed, in particular, reform-​minded eugenicists such as Carr-​Saunders, Society General Secretary C.P. Blacker, and Lord Horder, the King’s physician. The Society, it has been argued, appealed primarily to certain elements of the middle class.2 This can be construed to include both members of the professional middle class –​doctors such as Blacker –​and those, like Titmuss, from the ‘new’ middle class. Titmuss became an active Society member, and, in addition to its usefulness as a platform for his ideas, it gave him the opportunity, which he was not slow to take up, to gain important and influential contacts. While Titmuss had a genuine, almost obsessive, interest in population issues, there can be little doubt that he used the Society to advance his career. As we shall see, it was one of its leading members, the social reformer and feminist Eva Hubback, who suggested Titmuss to the historian Keith Hancock as a potential contributor to the wartime histories. Hubback was, indeed, to play a considerable part in his life. A  woman of extraordinary energy and commitment, she played a key role not only in the Eugenics Society, but also in, among other organisations, the Association for Education in Citizenship (which she co-​founded in 1934) and for which Titmuss was to write a pamphlet during the war, and the National Union of Societies for Equal Citizenship. She was deeply interested in population issues, including birth control and, as her daughter records, was familiar ‘with the writings of Carr-​Saunders and later of D.V. Glass, Alva Myrdal and Richard Titmuss, and indeed became friends with all these experts whom she met on common intellectual ground’.3 In the 1930s, like many progressive intellectuals, Hubback ‘hovered’, as Brian Harrison puts it, between Liberal and Labour. Harrison suggests that ‘Titmuss resembled her in this’, with socialism for him becoming the way to ‘keep up the birth-​rate’. This is overstating the case, and Harrison is on firmer ground when he remarks that it was one of Hubback’s ‘most fruitful suggestions’ that Titmuss contribute a volume of the war histories.4 Another important Society contact was Carr-​Saunders, first chair of the Population Investigation Committee set up by the Society in 1936 (Hubback was also a member), and discussed in Chapter 7 as Titmuss came to play a prominent role on it.

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Carr-​Saunders was to be a key player in Titmuss’s LSE appointment. Oakley records that the two had, by that point, been in correspondence for at least a decade, and that this involved meetings at Carr-​Saunders’s club, The Athenaeum. Carr-​Saunders, too, was close to Hancock.5 So what was eugenics? For Lucy Bland and Lesley Hall, eugenics is ‘too often discussed as if it were a clearly understood ideology, stable over time, and predictive of particular attitudes and sympathies in its adherents’. It is more plausible, then, to ‘argue that there was no one monolithic eugenics, either in beliefs or policy implications’. It could thus be embraced by, for instance, a wide range of political opinion.6 Certainly for its conservative, hard-​line, adherents, eugenics involved the belief that an individual’s social circumstances were shaped by inherited genes, rather than by socioeconomic environment –​nature rather than nurture. But as Michael Freeden suggests, there could also be an ‘ideological affinity’ between eugenics and ‘progressive thought’.7 In Titmuss’s case, this involved emphasis more on social environment, and less on biological inheritance. For Titmuss and those of like mind, the ‘genetic question’ could not be dealt with until there was greater equality in socioeconomic circumstances, brought about by ameliorative social intervention –​nurture rather than nature.This brought him into disfavour with more ‘traditional’ Society members who thought that any form of intervention was dangerously counterproductive, and that nature should be allowed to weed out ‘undesirables’. Richard Soloway claims that Titmuss was ‘appalled by some of the reactionaries’ he met on joining the Society, although it is unclear why he should have been unaware of them in the first place.8 The approach adopted by Titmuss can be illustrated by a brief examination of Poverty and Population, his first major work.

Poverty and Population As we have seen, this book contained a highly complimentary foreword by Lord Horder. And as an epigraph to the volume, Titmuss quoted King George V, who had asserted that ‘The Foundations of National Glory are set in the Homes of the People’. Titmuss acknowledged his new wife Kay’s contribution, ‘not only by her part in the publication of this book, but through her work among the unemployed and forgotten men and women of London’. Through her he had been able to visualise ‘the human significance, and often the human tragedy, hidden behind each fact, and the purblind social waste that the forces of poverty and unemployment relentlessly generate’.Two points already stand out. First, the clear relationship, for Titmuss, between poverty and

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unemployment, the scourges of 1930s Britain, and ‘social waste’, one of his recurring themes and part of his critique of ‘monopoly capitalism’. Second, Titmuss was not going to produce a book which took a hard-​line hereditarian approach to individual, and collective, social problems. Underpinning his argument was the belief that Britain’s population was both ageing and about to decline. That the latter was not, in fact, the case does not undermine the validity of Titmuss’s central argument. One consequence of changing population structure was that it was from the ‘poorer sections of the population, that the architects of the future are being increasingly disproportionately recruited’. This was problematic because this part of society suffered excess rates of mortality, and of morbidity, which were both concerns in themselves, as well as having implications for future generations. Poverty and deprivation were, though, concentrated in particular areas of the country. For example, when compared with the Home Counties, the North of England had, in terms of infant mortality, 65 per cent more excess deaths. Government reporting of such data was, Titmuss suggested, and for by no means the last time, misleading or inadequate. The book’s aim, therefore, was to ‘assess the extent, character and causes’ of this ‘social waste’.9 Titmuss then proceeded to statistically analyse these issues, and to propose solutions. Summarising his findings, he suggested that in the North of England, and in Wales, some half a million excess deaths had occurred in the previous decade.The evidence showed that behind such data lay the ‘presence of intense poverty’ on a widespread and considerable scale.These deaths were ‘not only a national, social and economic problem of fundamental importance’, they also were a humanitarian disaster, ‘a problem that cannot be dismissed, because they need not have died when they did’.The first priority, therefore, was to attend to the needs of children and mothers living in poverty. In what reads like a genuinely angry passage, but also illustrates his occasional tendency to priggishness and didacticism,Titmuss claimed these problems were being ignored or denied because of ‘British stoicism and complacency’. Indeed, he had started the book by condemning the ‘governing outlook on life of the majority of English people today’ (like many at this time, Titmuss routinely conflated England and Britain). This embraced the ‘unreasoning belief ’ that ‘the future will resemble the past’, and in so doing the population clung to the ‘principles of the obscurantist’.The continuance of ‘their contented, dull, mass-​belief lives, and their happy but nevertheless asocial preoccupation with respectable ritual’ depended on ‘the trends of to-​day and the shape of tomorrow remaining hidden’. Nothing must be allowed to disturb ‘their faith in the rigidity and

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rightness of the only society they know; not even the future prospects of national suicide’.10 There was more in the same vein. This was not to be the last time Titmuss was to castigate his fellow citizens for their short-​sightedness and moral shortcomings. But Poverty and Population certainly had an impact. One of its reviewers, in an article entitled ‘The Waste of Life’, was B. Seebohm Rowntree, one of the pioneers of poverty research. His work on York, some 30 years earlier, had been a landmark in social investigation, and he had recently re-​surveyed that city.Titmuss’s book, Rowntree suggested, was ‘important and startling’, and brought home the ‘true significance of the falling birth rate’. In turn, this emphasised the need to care properly for the younger generation, a task at which contemporary society, and contemporary policy, were signally failing. With touching naivety, Rowntree concluded that if ‘every Member of Parliament could be made to read this book, the demand to remedy the crying evils which it reveals would be irresistible’.11 Titmuss was less impressed by Rowntree. Over 30 years later, he told his friend Tom Simey that he agreed that Rowntree had been overrated. This he attributed partly to ‘the fact that these early pioneers by virtue of being pioneers have been credited with remarkable intellectual powers’.12 In the context of Titmuss’s critique of official statistics, and Rowntree’s plea that politicians read Titmuss’s work, it is worth stressing the lengths to which government departments went to deny any connection between unemployment, low income, poverty, and deprivation. The official line was that, in the case of the unemployed, the benefits they might claim were adequate to ensure their families’ and their own survival and health.The findings of researchers such as the nutritionist John Boyd Orr, for example his pioneering Food, Health, and Income, were ignored or downplayed in Whitehall, although they did have an impact on researchers such as Titmuss, and on more ‘progressive’ politicians and think tanks.13 Individuals like Titmuss and Boyd Orr were very much operating on their own initiative, and their work was crucial in bringing social problems to light in pre-​war Britain. Given what seemed like wilful blindness on the authorities’ part to the effects of unemployment and poverty, it might seem rather ironic that in 1937 the National Government introduced the Physical Training and Recreation Act. This sought to encourage British citizens to engage in more physical exercise, and was prompted by concerns that other nations, especially Nazi Germany, were pulling ahead of Britain at a time when the international situation was rapidly deteriorating. For critics, the idea that already malnourished individuals might benefit from exerting more energy was simply laughable, and in fact the campaign

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never really took off, and was quietly dropped on the outbreak of war. Titmuss was among these critics, noting that the ‘inauguration of the Government’s campaign does little more than imply the existence of ill-​health and inefficiency in our midst today’.14 Nonetheless, the campaign did recognise, however feebly, that population health had military implications. This was an issue Titmuss was soon to address. To return to the Eugenics Society, in October 1939 Titmuss joined its Emergency Committee, and by the early 1940s was playing a leading role in the organisation, and in the production of its quarterly publication, Eugenics Review.15 Shortly afterwards, when Britain had staved off the immediate threat of invasion, aerial bombing had ceased, and Germany had turned its attention to the Soviet Union, discussions over post-​war reconstruction began to move up the political agenda. One important landmark was the previously noted Beveridge Report of 1942. The Beveridge Committee had been set up in the summer of 1941, and in November Titmuss wrote to Blacker, now a captain in the Royal Army Medical Corps, on the Emergency Committee’s behalf. Titmuss had raised, at a previous committee meeting, the idea that the organisation should submit evidence to Beveridge. Would Blacker prepare a memorandum as, in Titmuss’s view, there was ‘no one in the Society competent to prepare such a memorandum apart from yourself ’? Titmuss also commented that, given his knowledge of how Beveridge operated from his own participation on a Political and Economic Planning (PEP) Committee on Social Security, any document put forward should be brief.16 Blacker replied, not unreasonably, that he did not, in fact, know very much about social security and, rather revealingly, that in any case he had given little thought to eugenics for the past two years.17 Nothing seems to have come of Titmuss’s initiative, and the Eugenics Society was not among the bodies listed as having given evidence to Beveridge. Titmuss’s exchange with Blacker is nonetheless revealing. First, there is mention of his involvement with PEP, an unofficial body undertaking important social research in the 1930s. It is not entirely clear exactly what level of engagement Titmuss had with this organisation. PEP’s practice of, for the most part, publishing its findings anonymously adds to the problems of identifying particular authors. Nor is there any mention of Titmuss in any of its main histories. Nonetheless, he did keep a file of material relating to PEP and knew, or came to know, a number of those actively involved, including Carr-​Saunders, and François Lafitte, a leading figure in the organisation in the 1940s.18 There are also at least two pieces in the PEP journal Planning, the first in 1936 and the second in 1940, which show Titmuss-​like concerns. The first

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draws on material which Titmuss was to use in Poverty and Population, while the second makes similar points to a pamphlet he produced for the Army Bureau of Current Affairs, discussed in Chapter 8.19 This piece also cited Poverty and Population. None of this is conclusive, and, given the contemporary interest in population issues, it is unsurprising that similar sources were used, and at least on some occasions similar conclusions reached. But it is suggestive, shows the tight-​knit circles in which Titmuss moved, and his association with ‘progressive opinion’, of which PEP was an important part in the 1930s and beyond. Second, why did Titmuss approach Blacker to write a memorandum in the first place, given his own interests in issues of this sort, and his willingness to use most opportunities presented to advance his own research and heighten his own profile? In part, the answer must lie in the fact that by late 1941 he was gearing up to carry out research for the Cabinet Office. Even Titmuss may have felt that doing detailed work for a Eugenics Society submission to Beveridge was a commitment too far, as well as contravening Civil Service regulations.

Government statistics and population health in peace and war Titmuss had not exactly been idle over the preceding years. We now look at another of his obsessions, the poor quality of government statistical data, and the implications of poor population health, German as well as British, for the impending war. Titmuss’s scepticism about government data was a recurring complaint from the 1930s onwards. Always keen to draw on history, Titmuss was fond of referencing population analysts from as far back as the seventeenth century, such as John Graunt and William Petty, key figures in the creation of ‘political arithmetic’.20 In a post-​war review,Titmuss described Graunt and Petty as ‘pioneers not only of medical statistics and vital statistics but of the numerical method as applied to the phenomena of human society’.21 By implication, the virtues of past researchers simply highlighted the vices of contemporary official data collection and analysis. Specifically on the latter, in early 1939 Titmuss wrote to H.W. Singer at the University of Manchester. Singer was a German refugee, one of John Maynard Keynes’s first doctoral students, and later famed for his work on the economics of developing countries.Titmuss had recently read a Ministry of Health report which denied any link between population health and economic distress. This contradicted both his own work and that of Singer. In response, Singer claimed that he knew that the Ministry fought shy of this linkage because of its ‘undue aversion to

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more refined statistical methods’.22 But while Singer was making a valid methodological point, there was more to it in that political concerns also came into play. There was a coda to this exchange which reflects well on Titmuss. In July 1940, he wrote to the Ministry of Information protesting about the ‘harsh and altogether shameful policy applied to the internment of refugees’. The government was hypocritical in claiming to seek to defend Europe while behaving in this way, and its actions were having a negative impact on American public opinion. Titmuss explicitly cited Singer’s case. The latter had helped Titmuss in his own work, and contributed to the Pilgrim Trust’s survey Men Without Work, an important study of the corrosive effects of unemployment. But he was now interned near Liverpool.23 Why? Over the preceding two months the German armed forces had had stunning successes in Scandinavia, the Low Countries, and France. This had prompted the government to intern ‘enemy aliens’, that is British-​based nationals of countries at war with Britain. By the time of Titmuss’s letter, France had fallen, and British and French military personnel had been evacuated from Dunkirk. The government was also tightening control over society through measures such as the Emergency Powers (Defence) Act, passed in May 1940. Most of the population felt a German invasion to be imminent.24 To take a stand on refugees in this understandably tense atmosphere showed courage on Titmuss’s part, and further evidence of his concern for civil liberties. Around this time Lafitte published an exposure of the treatment of ‘enemy aliens’, which Titmuss reviewed in early 1941. Lafitte’s book reminded British society of a ‘crime we committed in 1940, and for which we have not yet made full restitution’. It was necessary to ‘understand the nature of the war we are fighting, and that we discriminate, not between Britons and “aliens” or between “friendly aliens” and “enemy aliens” in the present way’. Rather, what was required was to distinguish between ‘those who stand for freedom and those who stand for tyranny in every country’. As Lafitte had demonstrated, the refugee issue was ‘indissolubly linked with the whole character and conduct of the present war’.25 To return to official data, in spring 1941, Titmuss, in a piece primarily concerned with inequalities in health outcomes, noted that for over three decades ‘we have relied on a Cost of Living Index based on family budgets collected soon after the Boer War’. While this might have been acceptable down to 1914, a lamentable lack of action ‘during the twenty uneasy years following the Armistice’ accurately reflected society’s failure to understand that the ‘condition of the people must always be at the root of all political doctrine in a democratic system’.

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The punchy title of this piece was ‘The Cost of Living and Dying’.26 A few months later, in a letter to the BMJ, Titmuss protested about what he called ‘the statistical black-​out’ of medical data in England.This was not the case for Scotland, though, where material released showed ‘a serious rise in both infantile and maternal mortality’. Immediate measures were required to deal with these. If the medical profession, and local authorities, were to act effectively, then information was crucial. Should the latter need to be withheld for security reasons, then ‘let the authorities be democratically frank and tell us so’. Either way, the situation should be consistent across the whole country.27 More specifically on the question of population health and war, in 1939 Titmuss was co-​author of Our Food Problem:  A Study of National Security.Titmuss’s fellow author was Frederick (‘Bill’) Le Gros Clark, despite his blindness a prolific writer, and a leading activist in organisations such as the Committee Against Malnutrition. Le Gros Clark was clearly an admirer of Titmuss, having recommended him, for example, as a speaker on malnutrition to the Medical Society at University College Hospital (UCH) in London.28 As we shall see in Chapter 9, political radicals at UCH were central to the development of social medicine. Titmuss had previously contacted Le Gros Clark suggesting a joint survey of the depressed areas, but the actual outcome of their collaboration was to be their book.29 The volume was part of the popular, and influential, ‘Penguin Specials’ series whose aim was, as Nicholas Joicey puts it, ‘to provide a topical commentary on international and domestic events’. Published in paperback, and relatively cheaply priced, the series was a ‘phenomenal success’, with a ‘significant number of titles’ selling over 100,000 copies.30 It should also be seen as part of a broader demand, especially from those on the progressive left, for informed commentary on current affairs, domestic and international.31 As the title of the Le Gros Clark and Titmuss book suggests, it was written with the deepening European crisis very much in mind. If war came, Britain would have to call upon its citizens ‘for a show of courage and endurance as great as any that their forefathers had reason to display’. In order to do so, though, national ‘stamina’ would have to be increased.This could be done through, for example, state-​subsidised milk for all pregnant and nursing mothers, all young children, all schoolchildren, and young workers up to at least the age of 25.The last group should also have access to subsidised canteens. While such schemes would undeniably be expensive, ‘we must take some measures if we are to survive’, and, in so doing, take a chance with the consequences. All this was ‘democratic’, for the ‘same rules of feeding hold good for

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rich and poor alike’. And while Britain was certainly living ‘through a serious phase in our history’, measures such as those suggested ‘could in a remarkably short time establish the physical and spiritual stamina of our people on a foundation that would be well-​nigh unassailable’. There was such a flimsy ‘borderline between normal and sub-​normal humanity’ that the ‘sacrifices we would have to make are trivial in comparison’.32 Phrases such as ‘normal and sub-​normal humanity’ jar on the modern ear. But these are seen here as positions on a spectrum, rather than the fixed entities a more ‘hard-​line’ eugenicist would claim. In summer 1939 Le Gros Clark wrote to Titmuss enclosing a cheque for £11. This reflected the proportion of the book, around one fifth, written by the latter. Sales were ‘at present almost thirty thousand. Not bad but might be better’.33 This was a considerable achievement, and one way in which Titmuss’s views were being brought a wider reading public. This particular volume was also cited as an authority in Eleanor Rathbone’s own Penguin Special, The Case for Family Allowances, in which she noted, too, that she was ‘indebted to Mr R.M. Titmuss for his help in providing me with some of my facts and figures’.34 Rathbone was a leading advocate of family allowances, a supporter of refugees, a campaigner for women’s rights, and an independent MP. Oakley suggests that she paid Titmuss to do certain calculations, and to read the entire script, resulting in an eight-​page memorandum which Rathbone duly took on board.35 Although the document in the Titmuss archives is undated, unsigned, and slightly shorter than Oakley suggests, it looks to be Titmuss’s response to Rathbone’s manuscript. Some of the comments, meanwhile, accord with Titmuss’s own preoccupations. For instance, he wondered whether longstanding family allowance schemes abroad had been of any assistance in raising the birth rate.36 Oakley also records a visit, as a child, to the Cornish cottage once occupied by Rathbone, suggesting a more than professional relationship between the latter and the Titmuss family.37 Titmuss’s friendship with Rathbone, who was also an intimate and collaborator of Eva Hubback’s, further illustrates the close-​knit, and influential, circles within which he increasingly moved. Titmuss’s growing reputation as an expert on population health resulted in work for the British state. This reputation, combined with his networking skills, meant that, as Oakley puts it, by early 1941 ‘the Ministries of Food and Information were fighting for his services’.38 Other departments likewise sought his expertise. In autumn 1940 he told Kingsley Martin that he was ‘at present advising the Ministry of Health’ on an in-​depth investigation of German vital statistics. No

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results were as yet available, and the work was being kept secret ‘as we do not wish the Germans to forbid the export to certain countries’ of various publications.39 In the letter to Blacker in late 1941 noted earlier, Titmuss also told him that he was working for the Ministry of Economic Warfare ‘on the trend of German Vital Statistics’, and that thus far a fair amount of material had been accumulated.The ‘trend of the conception rate’ was ‘rather fascinating –​the birth-​rate is dropping much more sharply than in this country’.40 It is not clear whether these were two separate projects, but the point is that Titmuss was in demand in official circles. Titmuss had already engaged with German population data, and it continued to be yet another of his concerns. In March 1939, for instance, he wrote to the editors of the American publication Population Index seeking information as to where he could find data on mortality rates for various countries, including Germany and the UK. This was one of several such letters searching out German mortality statistics.41 One outcome was an article in The Spectator, published just after the outbreak of war, addressing ‘Hitler’s Man-​Power Problem’. This, Titmuss claimed, underlay every social and military issue in Germany. For ‘six propaganda-​riddled years’ the Nazi government had tried to force up the birth rate ‘with every conceivable weapon’. Policies included family allowances, and the banning of contraception, but all had been unsuccessful.There were two main contributory factors to Germany’s ‘demographic battle’. The first was that Nazi ideology, ‘trimmed of all its mysticism’, was simply ‘a reversion to the ethnic level of the jungle’. Such an environment needed a high birth rate because it also entailed a high death rate, and the latter had been going up steadily under Nazi rule. The second was the continuing demographic impact of the First World War, which had seen both significant deaths and casualties, and the beginnings of a downturn in the birth rate. So Germany was not reproducing itself and, on the available information, its population would eventually decline. Hitler, then, for all his talk of the ‘sacredness of motherhood’, had chosen a path with the ‘surest means of destroying the fittest of his people, forcing down the birth-​rate, and of making certain that the German population will eventually decline. Of this sowing, like many others, Germany will eventually reap the harvest’.42 Titmuss’s analysis, including the point about the ‘finest’ being lost, was later shared by Hitler himself who, as the war went on and military losses mounted while the birth rate continued to fall, became increasingly concerned about his country’s demographic future.43 Titmuss returned to these matters in 1940 when reviewing a work on German medical data.This showed that mortality rates were increasing in every

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age-​group in German society, and especially those aged 1–​15 years and those aged 20–​45 years, and this was ‘borne out by the preliminary results of an investigation the present author is carrying out’. Similarly, and once again unlike most comparable societies, the German infant mortality rate was rising. The one ‘indisputable conclusion’ which could be drawn from the book under review was that ‘freedom is the first condition for the biological advancement of the individual and of the social group’.44 In the run-​up to the publication of the Spectator piece, Titmuss, writing on Eugenics Society matters to Ursula Grant-​Duff, asked her if she had read the recent book by R.R. Kuczynski,Titmuss’s entrée to the Society. This was Living Space and Population Problems, and Titmuss told Grant-​Duff that he had been in touch with Kuczynski ‘regarding certain aspects of the decline in Germany’s birth-​rate during the war –​ the last one’. The ‘most significant fact’ was that over 40 per cent of German women who had married in 1933/​34 had not given birth.45 As his own article had suggested, this was a knock-​on effect of the First World War, and one reason why Germany had an even poorer record in population replacement than Britain. Grant-​Duff would certainly have been interested in Titmuss’s observations not only from a eugenic point of view but also because she was, as Oakley notes, keenly interested in German affairs, and a fluent speaker of the language.46 Titmuss and Kuczynski, meanwhile, had a growing friendship, one outcome of which was that in 1946 the former wrote to the Home Office in support of Kuczynski’s application for British citizenship. Titmuss noted that he had ‘been personally acquainted’ with Kuczynski for around seven years, and had known of him as an authority on population for some time previously. The two had been meeting at fortnightly intervals as friends, and because of ‘our joint interest in population developments’, in which capacity Kuczynksi was ‘one of the greatest living authorities in this field’. Titmuss had a ‘very high opinion of his character as a scholar and as a citizen’. With his usual generosity in such matters, he concluded that Britain was indebted to Dr Kuczynski for his soon to be published population history of the empire. So ‘we should welcome Dr Kuczynski as a British Citizen. I am delighted that he has applied for naturalisation in this country and not in the United States’.47 Titmuss also helped other refugees from Nazi oppression. In early 1941 he was contacted by a member of the Czechoslovakian government in exile, its Minister of Social Welfare, M.V. Ambros. Ambros sought Titmuss’s advice about basic information on wartime conditions, and was trying to put together a picture of what Central Europe might

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look like after the war. He was especially concerned with health and food in relation to women and children. Titmuss responded almost immediately, declaring that he had ‘admired the work of the Czech Republic before the entry of Hitler’, and so would be ‘glad to help you in any way possible’.Always generous with his time, he suggested a meeting.This appears to have taken place, and in a further letter Titmuss suggested that Ambros might find it useful to approach bodies working on similar projects, for example that led by the highly experienced civil servant and politician Sir John Anderson under the auspices of the Ministry of Economic Warfare. Titmuss also offered to introduce Ambros to contacts at the Ministry of Health, as well as giving him advice on how to organise any data he gathered, urging him to identify whether particular food components, for example vitamins, were likely to be in short supply post-​war.48 But Titmuss’s first concern was Britain’s population health. Having identified serious problems among the population as a whole, as war became increasingly inevitable he turned his attention to their implications for the armed forces. The immediate context was the Military Training Act of spring 1939 under the terms of which 20 and 21 year old males were to be called up for six months of military training –​they were to be referred to, in this capacity, as ‘militiamen’ –​ before being transferred to the Army Reserve. This was a form of conscription, the first in peacetime in Britain, and further evidence of the sense that the country was heading towards war.49 In a piece published in The Spectator around the time of the act’s passage,Titmuss noted that in the previous year some 42,000 potential recruits had been rejected on medical grounds by the regular army. The majority had been between 18 and 20 years old, and so some would be conscripted under the terms of the 1939 Act. Since such conscripts would be medically inspected, this afforded the state an opportunity to gather information on this particular cohort, while raising concerns about the potential physical state of the militia.Titmuss then brought forward data which showed that over 50 per cent of those volunteering between the mid-​1920s and the mid-​1930s had been rejected on medical or physical grounds. The total number involved was 650,000 –​over double the number to be conscripted. This could not be solely attributed to the effects of unemployment as most of the potential recruits were in work, and hence it was a ‘grave indictment of the nation’s health’, suggesting that malnutrition among children and young people was ‘vastly more widespread than has so far been recognised’.The lesson was clear ‘to everyone who realises that we do not fight by guns alone’. If the nation’s manpower was to ‘marshalled

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in common defence then there should be not only the equalisation of wealth by conscription’, but also ‘the equalisation of health’. Poverty in Britain was a reminder that ‘freedom is best defended by attacking want’. If the people had to ‘rise in defence of their homes then let them demand that their homes should not be hovels and that their children should not be malnourished’.50 Titmuss pursued this theme for the rest of 1939. In November, the Eugenics Society Emergency Committee agreed that he should speak at the next meeting on ‘your findings with regard to the physical condition of the men of the new Army’.51 Titmuss also had letters on military health published in The Times, The New Statesman and Nation, and The Spectator. He commended The Times for highlighting the discrepancy between rejection rates on medical grounds for potential recruits to the regular army, and those conscripted to the militia. But the situation was even worse than reported, and he produced evidence to show why. Titmuss conceded, though, that as far as the militiamen were concerned only a small sample was as yet available. So he called on officialdom, in the interests of ‘the many sociologists, medical men, and others who are concerned with the state of public health’, to bring forward ‘an authoritative explanation’ of the apparent discrepancy.52 His contribution to The New Statesman and Nation made similar points, as well as explicitly citing a speech by Prime Minister Chamberlain, delivered since the publication of Titmuss’s letter to The Times. Chamberlain had made claims which, if true, refuted the work of those such as John Boyd Orr who had provided estimates of ‘the number of people existing in this country on a diet deficient in every essential respect’. It takes little imagination to work out what position Titmuss took. He concluded that it had been brought to his attention that young men rejected as unfit by the regular army had been passed as ‘fit for service’ by the militia, notwithstanding that an ‘insignificant’ period of time had elapsed between the two examinations. Therefore, in the ‘likely event of a considerable number of Militiamen electing to adopt one of the Defence Forces as a career’, was ‘the Government … prepared to transfer them without further medical examination’?53 Correspondence in The Spectator, meanwhile, derived from Titmuss’s article and involved, among other things, rebutting an army officer’s claim that his own observations revealed an immense improvement in the condition of recruits, thanks partly to the expansion of the social services.54 Essentially, Titmuss was arguing that the armed forces’ physical capacity could be undermined by bringing in recruits from the militia, and that this in turn reflected the poor condition of large swathes of the British population.This was clearly an injustice in itself,

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but also raised issues about potential military efficiency and performance. As he pithily put it in a book review at the beginning of 1940, ‘the functional capacity of nation whether at peace or war depends on the nutritional state of its people’.55

Conclusion During the latter part of the 1930s, and into the early part of the Second World War,Titmuss was not only politically active in a direct sense, he was also conducting research, and making polemical interventions, in the fields of population and population health. In both areas he saw himself as a contributing to arguments for what he would have seen as social progress, and in so doing he was prepared to take on leadership responsibilities. He was also beginning to establish himself as an influential figure in the Eugenics Society, and had made a number of contacts who were to prove important to his subsequent career. With the coming of war, his analyses of population and related issues led to his employment by various government departments. As if all this were not enough, and once again we have to remind ourselves that he had a full-​time job, Titmuss was also keen further to make his mark on a wider audience as an exponent of ‘progressive opinion’, and it is to this we next turn. Notes P.Thane, Old Age in English History: Past Experiences, Present Issues, Oxford, Oxford University Press, 2000, p 338. 2 R.A. Soloway, Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth-​Century Britain, Chapel Hill, University of North Carolina Press, 1990, pp 234, 316. For an approach to Titmuss’s association with the Eugenics Society which does not always take the same line as this volume, A. Oakley, ‘Making Medicine Social: The Cases of the Two Dogs with Bent Legs’, in D. Porter (ed), Social Medicine and Medical Sociology in the Twentieth Century, Amsterdam, Rodopi, 1997; and A.  Oakley, ‘Eugenics, Social Medicine and the Career of Richard Titmuss in Britain, 1935–​50’, British Journal of Sociology, 42, 2, 1991, pp 165–​94. 3 D. Hopkinson, Family Inheritance: A Life of Eva Hubback, London, Staple Press, 1954, pp 128, 134, 160. 4 B. Harrison, Prudent Revolutionaries: Portraits of British Feminists between the Wars, Oxford, Oxford University Press, 1987, p 296 and Chapter 10 passim. 5 Oakley, Man and Wife, pp 119, 148; and Father and Daughter, p 114. 6 L. Bland and L. Hall, ‘Eugenics in Britain: The View from the Metropole’, in A. Bashford and P. Levine (eds), The Oxford Handbook of the History of Eugenics, Oxford, Oxford University Press, 2010, p 216. 7 M. Freeden,‘Eugenics and Progressive Thought: A Study in Ideological Affinity’, Historical Journal, 22, 3, 1979, p 671. 8 Soloway, Demography, p 316. 1

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RICHARD TITMUSS 9 Titmuss, Poverty and Population, pp 1, x–​xi, xiii, xxvi. 10 Ibid, pp 308–​9, 3–​4. 11 B.S. Rowntree, ‘The Waste of Life’, The Listener, 8 December 1938, Supplement p xix. 12 TITMUSS/​3/​399, letter, 24 October 1962, RMT to Tom Simey, University of Liverpool. Simey had written the entry on Rowntree for the Oxford Dictionary of National Biography. 13 For a survey of material of this sort, and a critique of official attitudes, C. Webster, ‘Healthy or Hungry Thirties?’, History Workshop, 13, Spring 1982, pp 110–​29. 14 Titmuss, Poverty and Population, p xxiv. 15 EUGENICS, SA/​EUG/​A/​1/​32, Eugenics Society, Annual Report, 1939–​40. 16 EUGENICS, SA/​EUG/​C.333, letter, 16 November 1941, RMT to Blacker. 17 EUGENICS, SA/​EUG/​C.333, letter, 19 November 1941, Blacker to RMT. 18 R.C. Whiting, ‘Political and Economic Planning’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 19 ‘The Coming Fall in Population’, Planning, 73, 21 April 1936, pp 3–​15; and ‘Population Facts and Trends’, Planning, 165, 9 April 1940, pp 3–​15. 20 For a favourable reference to Graunt, see R.M.Titmuss, Birth, Poverty and Wealth: A Study of Infant Mortality, London, Hamish Hamilton, 1943, p 94. 21 RMT, review of Major Greenwood, Medical Statistics from Graunt to Farr, in The Economic History Review, 3, 1, 1950, p 146. I am grateful to Dr Margaret Pelling for this reference. 22 TITMUSS/​7/​47, letter, 31 January 1939, RMT to Singer; and letter, 2 February 1939, Singer to RMT. 23 TITMUSS/​7/​48, letter, 29 July 1940, RMT to Ministry of Information. 24 D.Todman, Britain’s War: Into Battle, 1937–​1941, London,Allen Lane, 2016, Ch 15. 25 R.M. Titmuss, ‘Aliens and Refugees’, Eugenics Review, 32, 4, January 1941, pp  136–​7. 26 R.M. Titmuss, ‘The Cost of Living and Dying’, The New Statesman and Nation, 5 April 1941, p 357. 27 R.M. Titmuss, letter, ‘Medical Statistics in Wartime’, British Medical Journal, II, 1941, p 562. 28 TITMUSS/​7/​47, letter, 9 March 1939, John Humphrey, UCH Medical Society, to RMT. 29 Oakley, Man and Wife, p 81. 30 N. Joicey,‘A Paperback Guide to Progress: Penguin Books 1935–​c.1951’, Twentieth Century British History, 4, 1, 1993, p 31. 31 Todman, Britain’s War: Into Battle, p 107ff where the author talks of a ‘reading “Popular Front” ’. 32 F. Le Gros Clark and R.M.Titmuss, Our Food Problem: A Study of National Security, Harmondsworth, Penguin Books, 1939, pp 91–​2, 176–​7, 178, 182. 33 TITMUSS/​7/​47, letter, 28 July 1939, Le Gros Clark to RMT. 34 E.F. Rathbone, The Case for Family Allowances, Harmondsworth, Penguin Books, 1940, pp 51–​2 and prefatory ‘Note’. 35 Oakley, Man and Wife, pp 126–​7. 36 TITMUSS/​4/​534, undated, unsigned, seven-​page typescript, p 7. 37 A. Oakley, Women, Peace and Welfare: A Suppressed History of Social Reform, 1880–​ 1920, Bristol, Policy Press, 2018, pp 7–​8. 38 Ibid, p 146. 39 TITMUSS/​7/​48, letter, 10 September 1940, RMT to Martin.

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The Eugenics Society, Poverty and Population, and ‘Manpower and Health’ 40 EUGENICS, SA/​EUG/​C.333, letter, 16 November 1941, RMT to Blacker. 41 TITMUSS/​7/​47, letter, 22 March 1939, RMT to Editors, Population Index, School of Public Affairs, Princeton University. 42 R.M.Titmuss,‘Hitler’s Man-​Power Problem’, The Spectator, 20 October 1939, pp 539–​40. 43 R.J. Evans, The Third Reich at War, London, Allen Lane, 2008, p 543. 44 R.M. Titmuss, ‘Rassenhygiene’, Eugenics Review, 32, 2, July 1940, pp 62–​4, reviewing M. Gumpert, Heil Hunger! 45 EUGENICS, SA/​EUG/​C.333 letter, 18 September 1939, RMT to Grant-​Duff; the book alluded to was R.R. Kuczynski, Living Space and Population Problems, Oxford, Oxford University Press, 1939. 46 Oakley, Man and Wife, p 113. 47 TITMUSS/​7/​54, letter, 15 March 1946, RMT to Under Secretary of State, the Home Office. 48 TITMUSS/​7/​49, letters, 28 February 1941 Ambros to RMT, 2 March 1941, RMT to Ambros, 17 March 1941, RMT to Ambros. 49 Todman, Britain’s War: Into Battle, 1937–​1941, p 158ff. 50 R.M. Titmuss, ‘Man-​Power and Health’, The Spectator, 26 May 1939, pp 896–​7. 51 EUGENICS, SA/​EUG/​C.333, letter, 10 November 1939, Business Secretary, Eugenics Society, to RMT. 52 R.M. Titmuss, letter, ‘Physique of the Recruit: Militiamen and Regulars’, The Times, 22 June 1939, p 12. 53 R.M. Titmuss, letter, ‘The Health of the Militia’, The New Statesman and Nation, 1 July 1939, p 15. 54 R.M. Titmuss, letter, ‘The Health of the Militia’, The Spectator, 21st July 1939, p 96. 55 R.M. Titmuss, ‘National Health’, Eugenics Review, 31, 4, January 1940, p 219.

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5 The Titmuss gospel and progressive opinion Introduction Previous chapters outlined a broad political, and social, historical sketch of British society as the 1930s moved towards war. But the points Stefan Collini makes about the era’s cultural atmosphere should also be acknowledged. As he puts it, the inter-​war period was notable for increasing concerns centred around the notion of cultural decline, alongside anxieties about the morally destructive effects of ‘modernity’. One component of such critiques was ‘a challenge to the category of “the economic” ’. On one level, this was part of a longstanding rejection, on the part of English radicalism, of traditional political economy, and of related ideas such as the ‘cash nexus’. But what was new was a ‘more sustained questioning of the place of economic activity in human life’, alongside ‘a more wide-​ranging exploration of the alleged cultural significance of its accepted centrality in “modern” society’. For this Chapter, what is especially important is that Collini sees R.H.Tawney, an intellectual mentor to Titmuss, as one of the principal exponents of such an analysis.1 Tom Rogan, in a study which deals in detail with Tawney, likewise suggests that, for much of the nineteenth and twentieth centuries, critics of capitalism focused especially on its ‘moral or spiritual desolation’.2 This was, therefore, an important constituent of the contemporary intellectual environment. Titmuss was determined to get his views across to as wide an audience as possible, and so sought to broadcast these in both scholarly and popular outlets. His co-​authored ‘Penguin Special’, discussed in the last chapter, was an example of a publication aimed at both markets, as well as targeting those of like mind, namely ‘progressive opinion’.This chapter builds on the preceding two as we further examine Titmuss’s

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engagement with progressive opinion in particular. As part of this, we also examine his critique of what he saw as contemporary society’s moral shortcomings, not least the obsession with economic matters at the expense of what was, or could be, truly valuable in human affairs. For Titmuss, this complemented his concerns over population, as well as informing his more overtly political activities.

Getting the message out One sign of Titmuss’s commitment to spreading his message, along with his growing self-​confidence as a writer, was, as we saw in Chapter 3, his engagement of J.M. Henderson as his literary agent. Henderson’s task was to try and place Titmuss’s writings with various print media outlets. For instance, he told Titmuss in spring 1939 that The Spectator had accepted the piece, discussed in the previous chapter, on health and manpower.3 A few months later,Titmuss sent Henderson the talk which he was about to deliver to the Liberal Summer School, discussed in Chapter 3, and ‘which might appeal to one of the better class monthlies’, for example Sociological Review. And if Henderson wished to ‘add to my qualifications you may be interested to know that I have just been awarded a Leverhulme Research Grant for work on Vital Statistics’.4 Titmuss’s article did not appear in Sociological Review, but his letter is revealing in showing that, given the award of the Leverhulme grant, he was being taken seriously as a researcher.Throughout his career he was to prove adept at gaining funding for his research, often out of necessity in the light of LSE frugality. In this context it is revealing that when, in 1940, he applied to become a Fellow of the Royal Statistical Society, that body expressed surprise that he was not one already.5 The correspondence with Henderson illustrates, too,Titmuss’s strategy of reaching out to general audiences, such as the readership of The Spectator, as well as a more specialised group, his fellow social scientists (of whom, it has to be acknowledged, there were not that many in inter-​war Britain). Titmuss also began to approach organisations directly with potential articles, another sign of his self-​belief. In late summer 1941 he sent a piece on ‘Planning and the Birth Rate’ to the Town and Country Planning Association, a progressive professional body which sought to encourage the humanistic planning of the built environment.6 The Association was clearly impressed, for the article appeared soon afterwards in its journal.Titmuss started by claiming that recent discussions of post-​war reconstruction, at this point very much in their early stages, had tended to focus on material issues, understandably given the impact of physical destruction. But such a focus forgot that ‘national life cannot

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continue unless the population replaces itself, that is, unless parents desire children’. Social reconstruction, thus conceptually enlarged, thereby entered ‘the realm of moral values; of social attitudes to parenthood; of belief in the future of man’. Titmuss then raised his usual concerns about declining fertility and imminent population decline. He also, appropriately given his audience, discussed building data and the need to embrace house planning’s social aspects, for example the particular needs of large families. But what is perhaps most striking is his underlying philosophy. If an environment could be created wherein parents consciously desired children, then ‘the physical environment, the multiple and interlocked social agencies for communal existence must be attuned to social values rooted in a co-​operative and not a competitive way of life’.7 We should pause here to say something about planning, an important strand in progressive thinking from the 1930s. At that time, unbridled capitalism appeared to have failed. It had brought about the Great Depression, the associated socioeconomic and political instability, and a questioning of some of the central tenets of classical political economy. Planning was likewise inherent in reform-​inclined eugenics, given its mission to rectify shortcomings in the quality of the racial stock. Progressive opinion was, as we have seen, often happy to go along with this, and Titmuss certainly shared such ideas. And there were models of planning which seemed to show the way forward. While most progressives would have rejected the Soviet Union’s political system, nonetheless its Five Year Plans appeared to be transforming its economy, as well as providing a barrier to the Great Depression’s ravages. In the United States, meanwhile, President Roosevelt’s ‘New Deal’ was more politically acceptable, an example of a liberal democracy intervening to promote economic revival and stave off social instability. Lloyd George, for instance, promoted the idea of a ‘British New Deal’. Social research was also looking into issues such as perceived problems in the social services and the healthcare system.8 Planning was seen as the solution to such ills, based as it was, or claimed to be, on empiricism and rationalism. To put it another way, it was ‘scientific’. Planning thus appealed to what Arthur Marwick famously described as ‘middle opinion’, that is those critical of both free-​market capitalism and Soviet communism, found in groups such as PEP, the Popular Front, the Next Five Years Group, and Lloyd George’s Council of Action for Peace and Reconstruction.9 Titmuss was linked to a number of these bodies, and was close to some of their leading figures. For instance, the Next Five Years Group included Laurence Cadbury and Eleanor Rathbone.10

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But to return to Titmuss’s underlying philosophy, also in 1941 The New Statesman and Nation, a leading journal of progressive opinion whose readership was expanding rapidly under Kingsley Martin’s editorship, published Titmuss’s punchy, provocatively titled, article, ‘The End of Economic Parenthood’. This was a relatively short piece, but worth considering closely as it articulates further some of the ideas hinted at in the Town and Country Planning piece, most notably social attitudes towards families and family size, and, underlying this, what Titmuss saw as modern capitalism’s warping of morality. The broader context of both these pieces is crucial. The bombing of British towns and cities was a recent memory, bringing, as it had, huge physical damage, a large number of civilian casualties, and, as in autumn 1939, the movement of significant numbers of people out of the country’s urban areas –​events described by Titmuss in Problems of Social Policy. And while Britain itself remained unconquered, in summer 1941 Hitler further escalated the conflict by invading the Soviet Union, initially with considerable military success.The United States had yet to enter the war, so while Britain had been reprieved, this conceivably might have been only temporary. Titmuss started his New Statesman piece with a series of propositions with which, he suspected, most people would disagree. These were that there was a relationship between the declining birth rate and the present ‘battle for existence’, these two phenomena being ‘twin expressions of one and the same thing’, and that the growth of monopoly capitalism and the production and sale of contraceptive devices were correlated. As a rhetorical technique, this was a clever way of drawing the reader’s attention to purportedly irreconcilable positions while, simultaneously, suggesting that there might be more to them than met the eye. In any event,Titmuss continued, there were only two ways under human control which could lead to humanity’s extinction:  mass suicide and the failure to reproduce. Again this is rhetorically clever, implying that the war itself was a form of mass suicide, and that the failure to reproduce might, too, be seen in this light. Given that Britain, with the rest of Europe, was failing to reproduce its population, two consequences of the conflict were possible, namely a ‘tremendous speed up … in the process of the dying out of the human race’, or a ‘complete reversal in our way of life so that an environment will emerge in which parents desire children’. Titmuss stressed that he was talking about the advanced capitalist societies, as the population of countries such as China was bound to rise ‘by hundreds of millions’ over the next 50 years. Although he did not have space to discuss this, the consequences of ‘an enormously increasing

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Asiatic population’ for the future of mankind raised ‘the most fundamental questions’.11 But why, in Western societies, should parents have to be encouraged to ‘desire’ children (a point also made in the Town and Country Planning piece)? Among the characteristics of such societies over recent decades were improvements in public health and the greater availability of contraception. So capitalist societies had gained more and more control over both the death rate and the birth rate. Focusing on the latter, why had the ability to control it been increasingly exercised? Here we can begin to discern what was to be a consistent theme in Titmuss’s thought, for he argued that the most ‘fundamental factor’ was the ‘psychological atmosphere of a society which places acquisitiveness before children’. Humanity’s impulse to serve the community –​the ‘altruism’ which became increasingly central to Titmuss’s philosophy –​had been denied by a society which told people that they must seek their own interests. Individuals were encouraged to regard wealth as ‘an index of biological success’, use that wealth to seek power, and ‘relegate morals to a two-​hour session of platitudes on the seventh day’. In such an environment, one which was an ‘unpleasant, unhealthy, and immoral blend of acquisitiveness and fear’, children were viewed as ‘economic handicaps’.12 Nor, in reality, did competitive individualism achieve much in terms of upward mobility because of the ‘chains of a static society’. Consequently, the struggle for success became ‘more and more demoniac’. Given the identification of children as economic burdens, so individuals increasingly controlled reproduction, and thus expressed in ‘a biological sense … feelings of moral frustration’. Such frustration created a ‘morally unhealthy society’, and all that had happened in inter-​war international relations was ‘but an outward expression of an inward disease’. Modern war was, then, a ‘temporary index of a morally unhealthy society’. Even worse, though, a ‘declining replacement rate’ was a ‘permanent expression of the same thing’. The present conflict, therefore, was not just another bout of Anglo-​German antagonism, or even a more generalised expression of human nature, it was also ‘a reflection on a mass scale of the individual’s disease’.The end of an era had been reached, and ‘vast and permanent changes’ were needed to Britain’s way of life. Failure to reverse the ‘refusal to reproduce’ might result in ‘some other species, perhaps a race of sub-​men’, arising ‘to take our place’. Control of fertility was essential,Titmuss conceded, to ‘a rational world civilization’. But without an understanding of what it could mean, ‘then control means extinction’. Thus in 1941 Britain was fighting not only for national survival, but also to ‘release that

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deep, long-​frustrated desire in man to serve humanity and not self ’.13 Titmuss, it should be emphasised, was not alone in his concerns about the psychological impact of modernity. As Mathew Thomson shows, psychology had a huge cultural impact, at both popular and intellectual levels, in post-​1918 Britain. It was also beginning to influence left-​wing political thought, most notably in the work of the economist Evan Durbin (encountered in Chapter 3), much admired by, among others, Tawney.14

R.H. Tawney and The Acquisitive Society These two pieces tell us much about Titmuss’s approach by the early 1940s, and should be seen alongside, for example, the contemporaneous arguments encountered Chapter 3 where Titmuss had used the platform of Unser Kampf to make similar points.They again show, too, Titmuss reaching out to different audiences:  the general, informed, readership of The New Statesman and the more specialist readers of Town and Country Planning. In terms of ideas, an obvious starting place is that parents must once again ‘desire’ children, rather than seeing them as economic handicaps. But they were being denied the opportunity to so by the ethos of an acquisitive society, a particular expression of monopoly capitalism. Once more, we find a clear acknowledgement of Tawney’s notion of an ‘acquisitive society’, a society which, in one formulation by Tawney, had grown ‘sick through the absence of a moral ideal’.15 It is thus important to outline briefly what ethical socialism involved, and Tawney’s account of why society had been taken ‘sick’, an idea also adopted by Titmuss. Ethical socialism has been described as a ‘radical tradition which makes heroic claims on people and on the society that nurtures them’. It offered a ‘guide to social reform aimed at creating optimal conditions for the highest possible moral attainments of every person’ and, as such, was a theory both of human nature and of society. The ‘good society’, then, could encourage but ‘could not ensure the creation of exemplary citizens’. Rather, the individual could not be absolved from making moral choices, and it was for society to facilitate such decision taking.16 The authors of this analysis were themselves undergraduates at the LSE immediately after the Second World War, that is, while Tawney was still teaching there, and just before Titmuss’s arrival. One, A.H. Halsey, became a friend of Titmuss’s, and his daughter’s sociology tutor. In any event, it was within the intellectual framework of ethical socialism that Tawney wrote of the ‘acquisitive society’, a concept which Titmuss was to utilise in various formulations for the rest of his career

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as a weapon with which to lambast the morally corrupting effects of contemporary capitalism. By the end of his career Tawney was, Collini notes, a ‘distinguished social and economic historian and doyen of the English tradition of ethical socialism’. Indeed, it was only a slight exaggeration to say that ‘Tawney became a historian in order to understand the origins of the distinctive pathology of modern society, namely the priority accorded to the pursuit of financial gain’.17 Michael Freeden, meanwhile, claims that Tawney ‘ascribed a powerful sense of altruistic fellowship to an ethically construed sense of community’. Freeden further contends that Tawney’s assertion of individual rights (not individualism) was part of his attempt to chart a version of social democracy ‘in an area hewn out between the denial of political liberty by both fascism and communism’, and ‘the denial of equal economic opportunities by the plutocracies of the West’.18 Titmuss has often been seen as a successor to Tawney. In one of many academic works making this linkage, John Offer argues that Titmuss was ‘impressed by Tawney’s writings’, that Tawney had a background in philosophical idealism, and that the latter hence went on to inform Titmuss’s own thought.19 Philosophical idealism, which argued an organic view of society, is another concept which recurs throughout this volume. The Acquisitive Society was published in 1921, underwent many reprints, and, although not without its critics, became something of a Bible for strands of the British left.20 Lawrence Goldman comments that the book was a ‘work of transition’, embracing Tawney’s earlier ‘moralism’ but also reflecting the author’s ‘growing social experience, economic knowledge, and desire to make general rather than personal arguments’.21 The timing was also important, for the devastation of the First World War, in which Tawney had played a courageous part, was fresh in British minds, one reason why Tawney’s arguments are so powerful and impassioned. That Titmuss was delivering his own critique of the acquisitive society in the articles under discussion during the second, even more devastating, global conflict of the twentieth century adds to the urgency, and seriousness, of his arguments. This is not the place to make a detailed critique of Tawney’s work. Rather, the aim is to pick out certain ideas and arguments, focusing primarily on the chapter entitled ‘The Acquisitive Society’, which might be seen as having particular meaning for Titmuss as he developed his own take on modern Britain, and its ills. Tawney argued that during the Industrial Revolution the idea became embedded ‘in England and in America’ that ‘property was held by an absolute right on an individual basis’. Consequently, ‘the

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enjoyment of property and the direction of industry’ did not require the provision of any ‘social justification’, as they were ‘regarded as rights which stand by their own virtue, not functions to be judged by the success with which they contribute to a social purpose’. During the nineteenth century, moreover, ‘the significance of the opposition between individual rights and social functions’ had been obscured by ‘the doctrine of the inevitable harmony between private interests and public good’. So was created ‘what may be called Acquisitive Societies, because their whole tendency and interest and preoccupation is to promote the acquisition of wealth’.This had been a powerful idea that had ‘laid the whole of the modern world under its spell’. It promised to ‘the strong unfettered freedom for the exercise of their strength’ and to the weak ‘the hope that they too one day may be strong’. In so doing, it made ‘the individual the centre of his own universe’ and, crucially, ‘dissolves moral principles into a choice of expediencies’. In such societies people did not become ‘religious or wise’, for to do so would be to accept limitations on the pursuit of wealth.There was thus an ‘appearance of freedom’, if it was accepted that such freedom was in pursuit of an object –​wealth –​which was nonetheless ‘limited and immediate’. In his conclusion, Tawney claimed that modern society was obsessed by economic matters, a ‘poison’ which ‘inflames every wound and turns each trivial scratch into a malignant ulcer’. Society could not solve its problems until that poison was expelled. To do so, it must ‘rearrange its scale of values’ so as to ‘regard economic interests as one element in life, not as the whole of life’. Its members would have to ‘renounce the opportunity of gains which accrue without any corresponding service, because the struggle for them keeps the whole community in a fever’. In short, the ‘instrumental character of economic activity’ had to be put in a position of ‘subordination to the social purpose for which it is carried on’.22 It is not hard to see here what appealed to Titmuss. Tawney’s arguments were historically grounded, as were so many of Titmuss’s. The latter’s critique of individualism, at least as understood and practised under contemporary capitalism, matches that of Tawney, as does his related appeal to ‘community’ and the best it can enable in individuals given the opportunity. It was to be a constant in Titmuss’s thought that, just as for Tawney, society and its aspirations could not be satisfied simply by the claims of economics, or the market, or materialism. But perhaps most interestingly in the context of Titmuss’s early wartime writings is Tawney’s notion of ‘the whole community in a fever’. For Titmuss, too, modern society had a pathological problem, deriving from the psychological strains of modernity, and the consequent disastrous moral

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sickness at both social and individual levels.The idea that societies, like individuals, could be ‘sick’ was, again, a recurring theme in Titmuss’s social analysis. It also sits well with the notion, noted in Chapter 3, of an ‘organic’ society, with its emphasis on human interconnectedness. Society can damage the individual, which, in turn, does further damage to the organism as a whole. As we have seen in his articles for Town and Country Planning and The New Statesman, Titmuss argued that the problems societies had in reproducing themselves were not distinct from but, on the contrary, were fundamentally linked to, and even among the causes of, the present war. Materialism and selfishness, and the psychological damage they inflicted, led to a declining birth rate, personal stress and unhappiness, and conflict. The message was clear, and built on and enlarged that of Tawney. A ‘morally unhealthy’ society had to be replaced by one which prioritised cooperation over competition, and enabled the release of humanity’s inherent altruism. Civilisation was at stake in the 1940s, with the possible alternative being a ‘race of sub-​men’. In short, morality had to replace the constant seeking of material gain.Titmuss’s revulsion at the single-​minded pursuit of material gain at the expense of all truly human sentiments was to be a further constant thread in his thought, informing his views on matters apparently diverse as how social workers went about their professional duties, the perils of an ‘Affluent Society’ in post-​war Britain, and voluntary blood donation.

Saving the poor and feeding the masses Just as ‘progressive opinion’ did not have the political field to itself, so too were Titmuss’s views not unchallenged. In early 1940, for instance, The Spectator published his article ‘Can the Poor Save?’The timing here is important as, in autumn 1939, the Chancellor of the Exchequer, Sir John Simon, had presented his first wartime budget. Unsurprisingly, this was geared to the demands of Britain’s prosecution of the war, squeezing taxpayers and consumers of goods such as sugar and tobacco. Shortly afterwards, following some government hesitation, the rationing of foodstuffs was gradually introduced. Bacon and butter, for instance, had restricted availability from January 1940.23 Titmuss’s article, and the response to it, thus came at a time when, notwithstanding that there was only very limited military action (the ‘Phoney War’), the British people were being asked to make sacrifices for the national good. And, of course, nobody could have confidently predicted the events which were shortly to follow, including the fall of France and the Battle of Britain.With the benefit of historical hindsight, 1940 has

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been identified as the ‘fulcrum of the twentieth century’, when the European order suffered staggering blows from which it was to take a long time to recover.24 In his original contribution, Titmuss argued that restrictions on consumption would unnecessarily punish the poor. It was ‘perfectly clear’ that a large section of the population could not cut down on their food intake ‘without running a grave risk to their health –​and to the nation’s well-​being’. Those with large families, moreover, were most at risk, for it was well known that ‘the more children there are in a family the lower is the standard of nutrition’. This was ‘startlingly illustrated’ by the fact that the death rate from bronchitis and pneumonia in one year olds from the poorest classes exceeded that of infants in rich and middle class families by 572 per cent. Any reduction in food consumption would inevitably lead to a reduction in family size, just as had happened in the First World War –​for Titmuss, a serious threat to Britain’s future.This was particularly ironic in the present circumstances, since if the ‘under-​privileged had maintained the same birth-​rate as the rich during the last thirty years we should not now have had sufficient man-​power to fight this war’. There should, therefore, be true equality of sacrifice, and strict controls on prices and profits.25 Titmuss was thus questioning part of the narrative of rationing, which in fact was popularly accepted, that there should be ‘fair shares for all’, and thereby equal contributions to the war effort by all parts of society. Titmuss’s article provoked a disgusted response from Dr Alice Mahony Jones (for British readers of a certain age she was, indeed, from Tunbridge Wells).As we shall see, his consequent reply questioned the coherence of Jones’s argument, and he had a point –​hers is a difficult letter to understand, or even summarise. But, in essence, Jones challenged especially Titmuss’s claim about infant mortality and class, ‘if only to prevent its return as a boomerang via Hamburg’. This now rather obscure geographical reference alludes to the location of the broadcasting station which transmitted the English language ‘Germany Calling’ programme, often led by the Anglo-​Irishman (William Joyce) nicknamed ‘Lord Haw Haw’. Jones questioned Titmuss’s suggestion of malnutrition (a word he had not in fact used) among poor children, at least in the sense of not having enough to eat (which is not what ‘malnutrition’ means). Rather, such children were being given the wrong foodstuffs (which is what ‘malnutrition’ means). And, according to her own records, over a 14-​year period the average weight of babies born to the poorer classes had ‘exceeded that of richer ones; which does not suggest that the mothers suffer from malnutrition’. If Titmuss’s data were correct, then the discrepancy in mortality was primarily due to

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the ‘ignorance and incompetence of the mothers’, attributable to low levels of intelligence and a lack of knowledge of hygiene.These could be addressed through education. Regarding the birth rate, and in a surprisingly progressive tone given what had gone before, she suggested allowances be paid to the mother for each child under the age of five alongside a recognition,‘in all classes’, that the ‘risk and ordeal of child-​ bearing’ was something ‘brave and public spirited, and not … a subject for condolence or crude humour’.26 This part of Jones’s letter could have been written by Titmuss’s friend Eleanor Rathbone, whose book The Case for Family Allowances had recently been published. Responding,Titmuss claimed to be ‘astonished to find in a member of the medical profession such abysmal ignorance of the progress made in the science of nutrition during the past fifteen years’. Her views about maternal incompetence and ignorance were, moreover, similar to those held in the eighteenth century, ‘when it was assumed that the poor represented an inferior strain of the population and that excessive infantile mortality was Nature’s salutary way of eliminating the unfit’. Titmuss recommended that Jones read various analyses of the relationship between income and nutritional standards, including that by the British Medical Association’s Committee on Nutrition. As to ignorance and incompetence, he preferred to ‘believe that the art of motherhood is as high in this country as anywhere in the world’. Titmuss noted, too, Jones’s jibe about providing propaganda material for the Germans. In retaliation, he asserted that she ‘apparently prefers to let it be known that the mass of the British working-​class are too ignorant and incompetent to bear the responsibility of children’. But he was not interested in the ‘nightly comic opera performance from Hamburg’, preferring instead to get at the truth of ‘the condition of the people of this country’.27 All this again places Titmuss firmly in the ‘progressive’ camp, and again shows his willingness to argue his case to a general readership in a publication, The Spectator, of a much more conservative disposition than its left-​wing equivalent, The New Statesman and Nation. As to Titmuss and Jones, theirs was, on one level, a relatively trivial spat, albeit on the important subject of the relationship between poverty and ill health. But it also reveals something of Titmuss’s views and character. It shows, for example, what he was up against in terms of what he clearly saw as reactionary and entrenched attitudes towards the poorest stratum of the working class, and especially its mothers. To put this in context, the recent evacuation of children from areas under threat from Luftwaffe bombing had not been unproblematic, involving negative perceptions of working class children and mothers

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among those upon whom they were billeted or who dealt with them by way of, for instance, voluntary social work. These perceptions did not go away, feeding into post-​war debates about ‘problem families’ in which Titmuss would have a part to play.28 There is a further twist here in that, as we shall see in the next chapter, Titmuss, the first person to comprehensively document the evacuation process, was to put a more positive spin on wartime social attitudes in Problems of Social Policy.This is pre-​figured, in his argument with Jones, by his defence of working class mothers, a commonly demonised group.And for those inclined to over-​read Titmuss’s membership of the Eugenics Society, his rejection of the idea that the poor should be constantly weeded out by ‘Nature’ is notable. Perhaps less appealing is his rather condescending dismissal of Jones’s remarks (silly though some of them were), not least as Jones was dealing with mothers and children on a daily basis, and of the ‘nightly comic opera performance from Hamburg’, a legitimate cause for concern. But there is also a potentially more serious problem, one which would come back to haunt Titmuss. His admirable resistance to the misrepresentation of working class mothers was part of a general unwillingness to blame the poor for their plight. Poverty thus becomes a purely structural problem which has, on this account, little to do with individual behaviour. This was to lay Titmuss open to the criticism that he had an unrealistic view of human nature and, perhaps equally damagingly, that he denied agency to the poor themselves. Such potential problems, and Jones’s critique, notwithstanding, Titmuss continued to use his undoubtedly up-​to-​date knowledge of nutritional science to effect, in the following case for the benefit of the wartime civilian and military population as a whole. In the summer of 1941 Gwilym Lloyd-​George, recently appointed Parliamentary Secretary to the Ministry of Food, wrote to Eleanor Rathbone about a letter she had passed on from Titmuss. The original does not seem to have survived, but Lloyd-​George reminded Rathbone that it had concerned ‘the waste of food values in cooking by restaurants’. He agreed that it was, undoubtedly, the case that ‘vegetables are wrongly cooked in many catering establishments, in the cook-​houses of the fighting forces, and in private homes’. Attempts to educate the public were being undertaken.29 If this had only been about the famous British tendency to boil vegetables to death, along with Titmuss’s somewhat obsessive, if commendable, concern with population health and diet, this would have been a fairly low-​level exchange of views. But, as noted, many foodstuffs in wartime Britain were rationed. Others were in short supply, not least because of the difficulty of importing them from abroad as German U-​boats attacked incoming convoys. So eating

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nutritionally valuable foods such as vegetables, cooked properly, was important if individual, and population, health were to be maintained. Equally, and again this was to be an important feature of Titmuss’s thought throughout his career, while his approach was fundamentally underpinned by his moralism, he was also a firm believer in scientific investigation, and the use of science and scientific data to inform his arguments.These were, in many instances, key components of progressive thought, including the version of eugenics which Titmuss espoused, and its approach to social problems.

Conclusion This part of this volume has shown, first, something of Titmuss’s background, his employment with the County Fire Office, and his marriage to Kay. His origins and early life were certainly modest, throwing into relief his subsequent career. From the perspective of Titmuss as a public figure, we have encountered his commitment, in the 1930s, to the Liberal Party, various organisations associated with ‘progressive opinion’, and then, in the early part of the war, Forward March. He was also, by the 1930s, committed to carrying out his own research, especially around concerns over the British population’s future size and health. Here, as at all points in his career,Titmuss was adept at networking, and this was an important component of his involvement with the Eugenics Society. By the same token he was not, it would appear, lacking in self-​confidence when it came to promoting his ideas, whether through public speaking or in print. These ideas at this point can be characterised as broadly ‘progressive’, or left liberal, and we have seen here and in preceding chapters how this informed, for instance, his moral critique of the ‘acquisitive society’. Such a society was, by such an account, not only wasteful in terms of its own human resources, it was also cruel and inhumane. Both Titmuss and his ideas were, by the time war came, already catching the attention of important and influential people. In the next part, we examine how all this played out throughout the rest of the Second World War and into the immediate post-​war era, by the end of which Titmuss had been installed as first Professor of Social Administration at the LSE. Notes 1

S. Collini, ‘Where Did It All Go Wrong? Cultural Critics and “Modernity” in Inter-​War Britain’, in E.H.H. Green and D.M. Tanner (eds), The Strange Survival of Liberal England: Political Leaders, Moral Values and the Reception of Economic Decline, Cambridge, Cambridge University Press, 2007, pp 247–​8.

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RICHARD TITMUSS 2 T. Rogan, The Moral Economists: R.H.Tawney, Karl Polanyi, E.P.Thompson, and the Critique of Capitalism, Princeton NJ, Princeton University Press, 2017, p 1. 3 TITMUSS/​7/​47, letter, 23 May 1939, Henderson of Stephen Aske, to RMT. 4 TITMUSS/​7/​47, letter, undated but summer 1939, RMT to Henderson. 5 Oakley, Man and Wife, p 89. 6 TITMUSS/​7/​49, letter, 23 August 1941, RMT to Town and Country Planning Association. 7 R.M. Titmuss, ‘Planning and the Birth-​rate’, Town and Country Planning, XI, 33, 1941, pp. 83–​5 (emphasis in the original). 8 P. Thane, Divided Kingdom: A History of Britain, 1900 to the Present, Cambridge, Cambridge University Press, 2018, pp 129–​30. 9 A. Marwick, ‘Middle Opinion in the Thirties: Planning, Progress and Political “Agreement” ’, English Historical Review, LXXIX, CCCXI, 1964, pp 285–​98. 10 D. Ritschel, ‘Next Five Years Group’, and R.C.Whiting, ‘Political and Economic Planning’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 11 R.M.Titmuss,‘The End of Economic Parenthood’, The New Statesman and Nation, 9 August 1941, p 130 (emphasis in the original). 12 Ibid, pp 130–​31. 13 Ibid, p 131. 14 M.Thomson, Psychological Subjects: Identity, Culture, and Health in Twentieth Century Britain, Oxford, Oxford University Press, 2006, pp 223ff, and passim. 15 Cited in Rogan, The Moral Economists, p 44. 16 N. Dennis and A.H. Halsey, English Ethical Socialism: Thomas More to R.H.Tawney, Oxford, Oxford University Press, 1988, p 1. 17 S. Collini, Common Writing: Essays on Literary Culture and Public Debate, Oxford, Oxford University Press, 2016, pp 181, 193. 18 M. Freeden, Liberal Languages:  Ideological Imaginations and Twentieth-​Century Progressive Thought, Princeton, NJ, Princeton University Press, 2005, pp 180–​81. 19 J. Offer, An Intellectual History of British Social Policy: Idealism versus Non-​Idealism, Bristol, Policy Press, 2006, p 4. 20 R.H. Tawney, The Acquisitive Society, London, G. Bell and Sons, 1921, and subsequent reprints. For the work’s status, B. Jackson, Equality and the British Left: A Study in Progressive Political Thought, 1900–​64, Manchester, Manchester University Press, 2007. 21 L. Goldman, The Life of R.H. Tawney, London, Bloomsbury Academic, 2013, p 189ff. 22 Tawney, The Acquisitive Society, pp 24, 27, 30, 32, 34, 241–​2. 23 D. Todman, Britain’s War: Into Battle, 1937–​1941, London, Allen Lane, 2016, pp 224, 271. 24 D. Reynolds, ‘1940: Fulcrum of the Twentieth Century’, International Affairs, 66, 2, 1990, pp 325–​50. 25 R.M. Titmuss, ‘Can the Poor Save?’, The Spectator, 23 February 1940, pp 244–​5. 26 A.M. Jones, letter, ‘Can the Poor Save?’, The Spectator, 1t March 1940, p 289. 27 R.M. Titmuss, letter, ‘Can the Poor Save?’, The Spectator, 8 March 1940, p 331. 28 See the references in J. Welshman, Underclass: A History of the Excluded since 1880, London, Bloomsbury Academic, 2nd edn 2013. 29 TITMUSS/​7/​49, letter, 13 June 1941, Lloyd-​George to Rathbone.

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Part 2

FROM PROBLEMS OF SOCIAL POLICY TO THE LONDON SCHOOL OF ECONOMICS

6 Problems of Social Policy: researching and firewatching Introduction From late 1941, Titmuss was engaged in researching and writing Problems of Social Policy, published in 1950.This was part of the ‘History of the Second World War: United Kingdom Civil Series’. Intriguingly, ‘Problems of Social Policy’ was the title of a passage in a 1932 work by Tawney.1 It was originally planned that Titmuss write two volumes on the wartime social services. In January 1951, he told a government official that the second was due later that year, and he would send him a draft when revisions had been made.2 But by this point Titmuss was fully occupied at the LSE. In a letter to the School’s director in late 1951, Titmuss complained about his workload. Consequently, he had had ‘to shelve indefinitely editorial work on the second volume’.3 By the summer of 1952,Titmuss had thrown in the towel, telling another government official that Margaret Gowing was taking over. He had been ‘reluctantly forced to give it up owing to extreme pressures of work here. I am finding that there are limits to human endurance!’4 The book which ultimately appeared had an introductory chapter by Gowing, but the principal authors were Sheila Ferguson and Hilde Fitzgerald. In a generous preface, Hancock noted that it had initially been envisaged that these two would work alongside Titmuss. But ill health, and the ‘pressure of University duties’, had led the latter to resign as principal author. Nonetheless, he had ‘continued to give assistance to his two colleagues, and the book they have now completed conforms closely to his original plan’.The volume itself made frequent references to Titmuss’s earlier work.5 As his correspondence suggests, Titmuss was not averse to letting others know how much he had to do, a habit maintained for the rest of his career.While Titmuss’s volume

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was not published until 1950, it is appropriate to deal with it here as it dominated his life for most of the 1940s.

The trials of authorship The Civil Histories series arose from the deliberations, in mid-​1941, of the Cabinet committee responsible for the War Cabinet’s Historical Section.6 The proposal received significant backing from senior politicians, and from a committee of professional historians, including Tawney, which advised the Historical Section. Keith Hancock, Professor of History at the University of Birmingham, was given overall control, with Titmuss recommended to him by Eva Hubback.At last, in January 1942, Titmuss was able to resign from his insurance job, and join the Cabinet Office, almost doubling his income. Hancock was to play an important part in Titmuss’s life in the 1940s. Outside work, they went on walking tours of North Wales and were firewatchers at St Paul’s Cathedral. Most importantly, though, Hancock became an admirer of Titmuss’s historical skills. In 1944, for example, he suggested that Titmuss lead a small group working on the histories ‘for discussion and mutual criticism’.7 In November 1945, meanwhile, Hancock told his historians that while up until now it had been impossible to give definitive instructions as to what any published outputs might look like, he was now ‘authorised to invite you to prepare a history publication’. Fourteen pages of guidelines were provided.8 In the preface to his own volume, Hancock outlined the origins of the series, what it sought to do, and the issues which had confronted the authors. It had been ‘accepted in the first place as a necessary war task and thereafter sustained with intense concentration of purpose and effort’. As well as following the ‘usual critical methods of professional historians’, contributors had been ‘compelled by the unusual problems confronting them to exercise a good deal of ingenuity in their methods of research’. While the official go-​ahead for the series as a whole came just after the war ended, Hancock noted, too, that three volumes had previously been agreed, and that of these the ‘problems of war time social policy stood clearly defined and were entrusted to Mr R.M. Titmuss’.9 Hancock’s faith in Titmuss was to be crucial in the deliberations, at the end of the decade, over the proposed Chair in Social Administration at the LSE. Titmuss’s research involved dealing with numerous official bodies, and a huge volume of material. As Jose Harris suggests, Titmuss and Michael Postan, writing on wartime industrial production, had particular problems since, in both cases, there was ‘the conceptual problem of how to interpret [the evidence], in an era when the very nature

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of total war seemed to insist that everything was integrally related to everything else’.10 Titmuss was also required to carry out other official work. In late 1943, for example, he told Hancock that the Ministry of Health had requested a statistical study of current trends in British and German morbidity and mortality, and that this would take around one week.The matter was to be raised in the House of Lords by Lord Cranborne, who had read a piece by Titmuss in The Lancet, presumably his brief analysis of German health data.11 Titmuss only spoke English, and he was assisted by the refugee German economist, Marie Meinhardt. Meinhardt was later to help Morris and Titmuss with their early research in social medicine.12 Titmuss was also engaged, in a return to his roots, as statistical advisor to Luton Town Council.The outcome was a book, co-​authored with Fred Grundy, the Medical Officer of Health.The authors made it clear that they were not providing a ‘plan for reconstruction’, but rather sought to present ‘basic physical and social facts as a guide to planning’.The work also noted the impact of evacuation, a central theme in Problems of Social Policy. At least as far as Luton was concerned, the ‘reception, medical inspection and billeting of 8,000 evacuees in three days passed off without confusion’. It was likewise recorded that infestation rates among evacuees, a source of much popular criticism, were no higher than those found in the local population.13 It is clear that Titmuss often felt frustrated, stressed, and angry during the writing of his volume.There was, for example, confusion over who was to cover what territory. In early 1944, Titmuss told Hancock that he had recently sent a draft on evacuation to the Department of Health for Scotland. The latter had responded that ‘Professor Mackintosh has agreed to write the war history from the Scottish angle’, and that this was to be ‘complete in itself ’.This was, as Titmuss put it, ‘news to me’, and he understandably sought clarification.14 No such Scottish volume materialised. There were also constant wrangles about the employment of research assistants, and the amount of material Titmuss had to handle. One positive outcome here was that in autumn 1944 Hancock was able to tell Sir John Wrigley, Deputy Secretary at the Ministry of Health, that Titmuss had been allocated a ‘new assistant to help him grapple with his greatly extended task’.15 In Problems of Social Policy Titmuss duly acknowledged the assistance of Mrs B.E. Pollard, Miss R. Hurtsfield, and, especially, Hilde Fitzgerald.16 As publication neared, Titmuss was increasingly convinced that the Stationery Office was not operating efficiently. In late 1949 he wrote to the Cabinet Office official with whom he frequently dealt, A.B. Acheson, with a series of complaints. Summing up, Titmuss told him

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that it seemed ‘a pity to invest so much labour and expense in the preparation of the Official Histories and then to be so dilatory and casual about publication and sales’.17 A year later, he again complained to Acheson, this time that no copies of his volume appeared to be available for sale, notwithstanding that it had been out for nearly nine months. He was fending off enquiries about its availability, and had first raised this issue the previous July.18 In reply,Acheson reported that, in fact, sales had already exceeded over 2,500 copies, and that it had been advertised in around 16 journals.19 As Harris points out, in the event the volumes by Titmuss, Hancock, and Postan ‘sold in substantial numbers’.20 But, again, we see Titmuss’s unhappiness when matters appear not to go his way. The central problem which he and his team faced, at least by his account, was that evidence, and commentary, arrived in a haphazard, unsystematic way.When drafts were produced, they were scrutinised not only by the Cabinet Office, but also by the government departments on whose evidence Titmuss depended, and which were wary about any criticisms perceived as levelled against them. They could also be maddeningly slow in responding.The Civil Service’s culture was challenging, perhaps especially to a newcomer. Shortly after the war’s end, for instance, Norman Brook, an immensely powerful figure soon to be Secretary to the Cabinet, told Hancock that Titmuss’s draft chapters which he had read were ‘very readable and interesting’, so promising ‘a good book’. He also had some mildly critical comments.21 Two years later, though, Brook, now Sir Norman, was more demanding. He produced a ten-​page memorandum which identified three main criticisms of Titmuss’s work: that the ‘treatment of pre-​war estimates of the probable scale of attack … is out of scale and to some extent out of place’, that the book was written ‘too exclusively from the Ministry of Health angle’, and that the draft had taken ‘insufficient account of the co-​ordination of Civil Defence work’. Brook, who had first-​hand administrative experience in a number of these areas, then elaborated at length.22 Others picked up such points.A Treasury official, identified only by the initials P.D.P., disputed Titmuss’s criticisms of his department (which, in the published version, were in fact relatively mild). But ‘quite apart from the Treasury interest’, he had found the volume a ‘thoroughly bad book’. It was a ‘niggling production, written from a single, very narrow, point of view’. Brook’s comment that it was the ‘war as seen from the Ministry of Health Registry’ was exactly right. Finally, the book’s title was misleading as a range of ‘social policy’ issues were not covered. So, the ‘proper thing to do’ was to ‘tear it up and

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start all over again’.23 We might recall here Hancock’s comments on the clarity of what constituted wartime social policy, and that Titmuss was the person to write about it. Brook was problematic in another, related, way.Titmuss addressed his criticisms in April 1948, accepting some points, rejecting others.24 As he told Acheson the following July, Brook had not, as yet, responded. Nor had he received any Treasury feedback, so presumably the document cited earlier had not yet reached him.25 The following month, Titmuss informed Hancock that he had had a useful discussion with Acheson, and had apologised to him for all the difficulties he had apparently created. It was unfair on Acheson to have to sort everything out, though Titmuss had found it ‘very hard to restrain my temper’. He again complained of the lack of feedback from both Brook and the Treasury, before apologising for this ‘outburst’. But he had ‘not quite simmered down yet’.26 Further difficulty from Brook came in spring 1949. As writing neared completion, Hancock raised a series of issues, mainly to do with the availability of new evidence. Hancock told Brook that Titmuss had been the only contributor who had ‘always done what he ought to have done at the right time and in the right way’. For ‘this reason alone –​but of course there are others –​I must do my utmost to win his willing consent as author of the book, if I, as editor, should be convinced that in certain parts there is still room for substantial improvement’. Both Titmuss and Hancock should look at the new evidence ‘with a completely fresh and open mind’, and achieving this would be helped by everyone ‘tackling in the same spirit the new revealed problems of handling drafts for circulation and getting the final copy through the printing stage’.27 It is clear that Titmuss was resistant to what he undoubtedly saw as unnecessary extra work. More positively, we again see Hancock’s faith in him, both as an historian and, as Harris puts it, as a ‘tough potential ally in the face of excessive official back-​tracking and obstruction’.28 Another episode of this type occurred a few months later. Titmuss received a letter from Acheson on behalf of himself, Brook, and another Cabinet Office official, A. Johnston. The three had a number of criticisms of the latest version of Titmuss’s volume, by this time at galley proof stage and, in principle at least, only a few months from publication. For instance, ‘Mr Johnston still feels that it is unfortunate that so little is said about what the emergency medical service did for air raid casualties’.29 Titmuss’s immediate response was a four-​page letter to Hancock, a letter which ‘I simply loathe writing to you’, because he thought that the issues raised by Acheson had been resolved at an

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earlier meeting in Oxford between all interested parties. But he was also anxious that Hancock not think he was suffering from ‘persecution mania’. Nonetheless, the Oxford meeting notwithstanding, there had been a stream of written and verbal comments from the Cabinet Office, so that ‘now my mood is one of rebellion’. He then took on Brook and Johnston’s criticisms. On the issue of the Emergency Medical Service and air raid casualties, to use the example raised by Johnston, this would involve new research, rewriting another chapter on the hospitals, and encroaching on another volume in the series, that on the medical services. Ominously, he expected more such Cabinet Office criticism.‘Quite frankly’, he told Hancock,‘I cannot stand any more of this.’ The Cabinet Office did not seem to appreciate the toll his work had taken on his health, and on his leisure time. He had had one week off in 15 months, and in this particular week had worked almost every day.There was also the possibility of a loss of income due to difficulties in his relationship with the Medical Research Council, by which he was at this point employed (see Chapter 9). After a further series of complaints, again about the Stationery Office, he concluded: ‘It would be astonishing if, by now, you were not tired and critical of this letter and of me. I am very, very sorry, Keith.’30 Not all commentators were critical, though. In December 1943, the Regius Professor of Modern History at Oxford, F.M. Powicke, informed Hancock that he had read Titmuss’s draft on evacuation ‘with much admiration’. Titmuss had a ‘natural gift, cultivated and strengthened by his earlier experience, for the exposition of complicated fact in the manner of a historical student’. He could, moreover, on occasion ‘write with much force and clarity’. Hancock had been ‘fortunate to have found Mr Titmuss’, and Powicke hoped ‘very much that every facility, finance included, will be given him to complete the full plan of the Social Services survey’.31 In early 1946, James Alison Glover, Deputy Senior Medical Officer at the Ministry of Health, told Titmuss that he had studied the material supplied ‘with attention’. It was an ‘admirable study of recent history, brilliantly expressed’.Although Glover had been involved in a number of the events described,Titmuss had thrown fresh light on some of these, while bringing others to his attention for the first time. Glover had a few minor suggestions but, overall, he ‘very warmly’ congratulated Titmuss.32 From the Department of Health for Scotland, meanwhile, A. Bruce Auckland responded to Titmuss’s drafts on evacuation. Again, only minor changes were suggested. Auckland added that he had had ‘several complimentary comments on the way the chapters have been written … One person said you were “making a grand job of it” ’.33 From a Scottish civil servant, gushing praise indeed.

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And in 1949, the Ministry of Education’s Permanent Secretary, Sir John Maud, told Brook that he had not had time to fully absorb the part of Titmuss’s draft dealing with the later stages of evacuation, the hospital services, and social care. But several colleagues had ‘studied it carefully’. From what they had told him, and what he had gleaned from his own preliminary reading, it was clear that ‘it is a fair, well balanced and wise appreciation of what took place’.34 This was an especially intriguing letter. Maud, like Brook, was a high-​flying civil servant, and they would have known each other well. So did Brook seek Maud’s advice, or did Maud offer it unsolicited? Was Maud aware of the criticisms of Titmuss by Brook and his colleagues that was currently circulating? It would have been surprising if he was not. In any event, Titmuss had supporters in Whitehall, as well as critics. This even extended to the Treasury. In March 1950 Titmuss wrote to an official thanking him for ‘the trouble you took in writing letters about reviews of my War History.The article in the Manchester Guardian yesterday was excellent and pleased us all’.35 The tensions involved in the volume’s production notwithstanding, Titmuss’s labours undoubtedly made an impact, even before its actual publication. Shortly after the announcement that the series would go ahead, Titmuss was contacted by the Professor of Economic History at the University of Cambridge, and editor of Economic History Review, Michael Postan. Postan had been educated at the LSE (including by Tawney), had taught there, and was central to the Civil Histories series. It was with his editorial hat on that he wrote, offering Titmuss the chance to ‘introduce yourself to economic historians’ by contributing an article to the Review ‘on public health services during the last forty years or, say, since Lloyd George’.Were he to do this for publication in the coming year,‘it would probably also serve as a background study for your synoptic volume’.Titmuss regretfully turned this offer down, due to the demands of Problems of Social Policy.The type of study Postan had suggested, Titmuss agreed, did not presently exist, and was ‘something I have wanted to do for a while, but have never had the time’.36 It was a small enough incident in its own way, but nonetheless Postan, like Hancock and Powicke a professional historian, clearly had a positive view of Titmuss’s own historical abilities.

The history of the Home Front Titmuss’s analysis of the war’s domestic impact can be summarised as follows. First, the conflict engendered a sense of social solidarity and moral purpose –​the Dunkirk or Blitz ‘spirit’ –​where everyone was in

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it together, sharing equally in necessary sacrifice, while fundamentally questioning pre-​existing ideas and practices. Second, the war revealed, notably through the process of evacuation, the poor condition of Britain’s urban working class. This awakened the nation’s conscience and had both immediate effects, for instance a more humane attitude on the part of social service providers, as well as contributing to rising demands for post-​war social reconstruction. Social solidarity further enabled a consensus over such reconstruction. Third, British citizens came to see the government as the mechanism whereby social injustices could, indeed should, be remedied, and the government duly responded. This contrasted with the official inertia of the 1930s. Fourth, the war and its aftermath, with the rapidly expanding social services eventually coalescing in the ‘welfare state’, again stood in contrast to the economic depression, and poor social provision, of the preceding decades.As John Welshman elaborates, Problems of Social Policy articulated many of what were to become key features of the ‘Titmuss paradigm –​his optimism about human nature, belief in universal services, and opposition to means testing’.37 Titmuss’s work runs to over 500 pages, plus appendices. On one level it is a detailed analysis of particular areas of experience, and of health and social service provision.The volume remains indispensable to those working on civilian life and official policy during the Second World War. Structurally, it adopted for the most part a chronological approach, starting with the build-​up to war. Then comes the era of ‘The Invisible War’, whose main characteristic was the first wave of evacuation of children from areas threatened by aerial attack. This is followed by a section on the impact of aerial bombing when it actually arrived, including an important discussion of civilian mental health. This had been of concern before 1939, particularly to psychiatrists and government officials who had feared a collapse in morale. But Titmuss demonstrated that these fears had not been realised. The next part deals with ‘The Long Years’ following the Blitz. It describes both the second wave of evacuation, and hospital care for the civilian casualties of war as well as for those who needed such treatment for ‘normal’ reasons. Throughout the book, Titmuss was not unwilling to criticise local authorities and voluntary agencies. Nonetheless, such bodies had often learned from experience, and adapted positively. Eleven statistical appendices follow the main text. Later, however, the focus is not on the data Titmuss gathered and analysed, monumental task though this was, or on issues such as the mechanics of evacuation, or the workings of the administrative machine. Rather, we examine the conclusions

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Titmuss drew from the civilian experience of war. This comes in the last chapter, challengingly entitled ‘Unfinished Business’. First, though, we briefly consider Titmuss’s methodological approach. He noted the huge volume of material available to him, official and unofficial, within which lay ‘the essential facts for a history of the social services during the Second World War’.The historian therefore had to untangle changes in policy on a case-​specific basis before assessing ‘the results achieved’. The outcome would thus be a ‘social history’ (not, it is worth remarking, a generally recognised branch of historical study at this time). But writing such a work was difficult, especially when the author was ‘so close to events’. A further problem was generalising at the expense of ‘concreteness’. He had, therefore, selected problems for ‘exact investigation’, using the method of ‘selective illustration’. Titmuss then outlined the book’s structure, noting that in its final part the ‘dominant theme’ was the strain of war on family life because the ‘needs that arose challenged the existing character of social service, shifted the emphasis in policy, and called into play new instruments of welfare’.38 It is worth digressing here to consider Tawney’s 1932 inaugural lecture at the LSE. Here he argued that history was concerned with ‘the life of society, and with the records of the past as a means to that end’. There was, then, some truth in ‘the paradox that all history is the history of the present’. Strikingly, Tawney also suggested that societies changed not simply because of economic factors, but through a range of interconnected causes, with the ‘most neglected factor in social development’ being war.39 We do not know whether Titmuss was aware of this lecture, and, of course, he drew much of his analysis from his own experiences. Nonetheless, his approach and conclusions do, in the light of Tawney’s views, suggest his mentor’s influence. So what of Titmuss’s ‘dominant theme’ and ‘unfinished business’? By 1945 the state had ‘assumed and developed a measure of direct concern for the health and well-​being of the population’, a change which, when contrasted with the 1930s, was ‘little short of remarkable’.This had been achieved through both new and existing services, embracing all social classes. National resources were pooled and risks shared, and acceptance ‘of these principles moved forward the goals of welfare’. Titmuss acknowledged that little of this was planned in advance, but insisted that, for instance, ‘the condition of evacuated mothers and children aroused the conscience of the nation’, which led directly to proposals for reform, leading in turn to state action. To take another example, the expansion of state-​provided school meals, previously a poorly regarded scheme, generated something

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‘very close to a revolution in the attitude of parents, teachers and children’. From a service with a Poor Law taint, it had become ‘a social service, fused into school life, and making its own contribution to the physical nurture of the children and to their social education’. Further positive attitudinal change could be found in the ‘quality of the Assistance Board’s work, and in the relationship between its officers and its clients’, another contrast to the 1930s. Here Titmuss was referring to the Unemployment Assistance Board, set up in 1934, the cause of much resentment among the unemployed because of its intrusive methods of assessing benefit. Analysing an indicator of social wellbeing in which he had a longstanding interest, Titmuss recorded a wartime fall in the infant mortality rate which would have been ‘considered as a remarkable achievement in peace time’. Indeed, the data showed not just a decline, but one historically almost unprecedented. Reviewing the population’s health more generally, government action after 1939 to ‘safeguard the nation’s health’ had been ‘far more effective than anyone expected or thought feasible’ before that date. But what Titmuss was especially keen to emphasise was a change in values early in the conflict when invasion threatened, followed by the bombing of major urban areas. If ‘dangers were to be shared, then resources should also be shared’. So commonality of purpose meant benefits in common, but also obligations on the part of individuals, one to another –​‘Dunkirk, and all that name evokes, was an important event in the war-​time history of the social services’. The subsequent difficult years ‘served only to reinforce the war-​warmed impulse of people for a more generous society’.40 It should be stressed that Titmuss was neither naïve, nor an unthinking optimist, anxious only to show the British at their best. He recognised that, even with the improvements which had been made, certain social problems still had to be addressed –​hence the ‘Unfinished Business’. It is therefore important to remember that the book was published in 1950, by which time the key measures of the ‘welfare state’ were in place. We do not know precisely when Titmuss wrote this chapter, but it seems likely that he was already looking forward to what social policy might achieve.What we do get, though, is the very strong sense that the war had brought about a fundamental change, especially in social values. The clear message of this chapter, and it is different in tone from the statistically dense other parts of the book, was that people working together, with duties as well as rights, can, within a framework of beneficent state action, build a better society –​the new Jerusalem promised by Labour leader Clement Attlee during his successful 1945 election campaign.

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Lady Allen and Lady Reading In August 1944,Titmuss told Lady Allen of Hurtwood (Marjory Allen) that any history of the wartime social services would be incomplete ‘without reference to the work of the voluntary organisations operating in this field’. He was, therefore, seeking information from Allen in her capacity as Chair of the Nursery School Association, a body which campaigned for expanded pre-​school educational provision. A  meeting was duly arranged for late September.41 Although their early correspondence is formal, it seems likely that Titmuss and Allen already knew each other. Both moved in ‘progressive’ political circles. Allen’s husband, for instance, had founded the ‘Next Five Years Group’, a body committed to social and economic reform, especially active in the mid-​1930s.42 In any event, they built up a working relationship in which Allen sought Titmuss’s advice, while he made a number of revealing comments about the current state of welfare provision, and thereby his own approach to the social services. Shortly before their meeting, Allen wrote to The Times on ‘Children in “Homes”: Wards of State or Charity’. She raised the issue, as yet unaddressed by plans for reconstruction, of ‘those children who, because of their family misfortune, find themselves under the guardianship of a Government Department or one of the many charitable organisations’. Many were being brought up ‘under conditions that are generations out of date and are unworthy of our traditional care for children’. Of these, a large number still lived ‘under the chilly stigma of “charity” ’, and in both public sector and charitable homes many staff lacked formal training, and were not subject to inspection. Allen therefore called for a public enquiry into ‘this largely uncivilised territory’.43 Even such a brief summary might suggest why Titmuss and she would get along, the lack of professionalism in children’s homes being a case in point. And Allen, like Titmuss, was highly critical of ‘charities’ which, due to their dependence on state support, were not truly voluntary bodies. Early in 1945 she expanded her case in the pamphlet Whose Children?, a copy of which she sent to Titmuss. Titmuss recorded that at their September meeting some of the points Allen had raised related to the unrepresentative composition of the governing bodies of many voluntary homes while, in her view, the ‘Orphanages and Homes run by the Roman Catholic Church are the worst’.44 In response,Titmuss noted that Allen’s analysis would be incorporated into Problems of Social Policy. In a revealing comment about what he saw as the current shortcomings of officials in both voluntary and public welfare, he told her that ‘You know it is the same type of mind

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that dominates the governing bodies of the charitable homes and the Public Assistance Committees. But what minds and what a shocking indictment it is!’45 He was also critical of any welfare provision which smacked of ‘charity’, and the stigma it entailed. But it would be wrong to read Titmuss’s letter as an attack on voluntarism as such, for what he was suggesting was that the manner in which social services were delivered was just as important as who was doing the delivering. As far as the voluntary sector was concerned, a distinction could also be made between patronising ‘charity’, which might actually be heavily reliant on state support, and unselfish, altruistic voluntarism. Partly because of Allen’s agitation, an official committee, chaired by Dame Myra Curtis, was set up to examine the situation of children ‘deprived of a normal home life’. Allen told Titmuss how pleased she was with how quickly the government had acted, and that the committee’s ‘terms of reference are excellent and very wide’. 46 The Curtis Committee reported in 1946, with its major proposals being incorporated into the 1948 Children Act, an important, if sometimes neglected, component of the ‘welfare state’. Among the recommendations implemented were that local authority children’s departments should be established, and that there should be a move away from large-​scale residential homes towards adoption, and boarding out. All this was very much in line with contemporary thought about children and the family in post-​war society, including the desirability, whenever possible, of keeping children with their biological parents. Much to her annoyance, Allen was not invited to join the Curtis Committee, but she did devote her considerable energies to ensuring it proceeded in an acceptable direction. She set up an informal discussion group on the subject, which Titmuss joined.47 When called to appear before the committee, Allen again sought Titmuss’s assistance. She had drafted a memorandum, and would be ‘greatly fortified if you would read it through and tell me whether you think it has any value’. In a passage illustrating the regard in which Titmuss was now held, Allen claimed that she had had great difficulty in writing one particular section, and was worried about its accuracy, so ‘I can, of course, delete the section entirely if you feel that it is not adequate’.48 Titmuss’s response does not appear to have survived, but Allen did write again a few weeks later enclosing a copy of her submission.‘You will see, with amusement I expect’, she wrote, ‘that I have used quite shamelessly many of the valuable points you raise in your letter.’49 A few years later, as the Children Bill made its way through Parliament,Allen once more sought Titmuss’s advice. She was preparing an article for The Times, and part of her criticism of the Bill was that

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it did not ‘abolish the idea of children on the proceeds of charity’, by which she meant that homeless children might still come under the supervision of a certain type of voluntary body. She also criticised the major children’s charities as being ‘so vast they are almost like a chain-​store and the child as an individual is lost’. At the other end of the spectrum, some children’s homes were small and poor, both financially and in terms of ideas. She especially wanted Titmuss to comment on her ‘paragraph about the voluntary organisations not in fact being voluntary’.50 Titmuss presumably did so, and Allen’s article was duly published. This generally welcomed the Bill but was critical, as Allen’s correspondence with Titmuss would suggest, about the potential role of voluntary organisations (although she was careful, like Titmuss, to defend the voluntary principle). Returning to a common theme in her (and Titmuss’s) approach, Allen argued that it would be a ‘fine thing to abolish altogether the necessity for any child to be dependent on charity’.51 Titmuss’s engagement with Allen is revealing. She was a seasoned campaigner, ten years his senior, whom he had initially contacted because he wanted material for Problems of Social Policy. This he duly received and incorporated, along with the findings of the Curtis Committee, in a passage on evacuation which noted that ‘some local authorities did not take all their normal welfare responsibilities seriously’, and that the use of voluntary visitors to be responsible for the care of evacuated children was ‘sometimes little more than a way of enabling visitors and their friends to obtain a supply of domestic servants and labourers’. More positively, though, Titmuss acknowledged the role of bodies such as the Nursery School Association in pressing local authorities to provide nursery accommodation for evacuees.52 It was Allen who then turned to Titmuss for advice and information. They had a number of ideas in common about social service provision, and shared a degree of scepticism about certain types of voluntary organisation. Both, too, were concerned with the quality of staff carrying out welfare functions, and determined to remove any stigma attached to services provided on a charitable basis, in particular. Of course, this should not be overstated. No doubt Titmuss and Allen disagreed about certain policy issues, but their mutual respect is striking. This is further reflected in an approach to Titmuss by another titled lady involved in social welfare, Lady Reading, Chair of the Women’s Voluntary Services (WVS). This organisation, which Reading had founded, and in which she remained the dominant figure, had been heavily involved in wartime social service. It was essentially a hierarchical, middle class body, although during the war it successfully

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recruited significant numbers of working class women. It continued, post-​war, to play an important part in the voluntary social services. In Problems of Social Policy it was the voluntary organisation most frequently referred to. While commentary was mostly factual, Titmuss acknowledged, for example, that in dealing with London’s homeless the ‘contribution made by voluntary workers, and notably by the Women’s Voluntary Services, was, perhaps, greater in this field of war-​time service than any other’. He suggested, though, that, as in the public sector, there were different levels of efficiency and organisation so that the ‘quality of work … of the local centres of the Women’s Voluntary Services varied enormously’. Nonetheless, organisations such as the WVS could react quickly to events  –​at best they were ‘flexible’ –​and on occasion had been instrumental in forcing the state, local and national, into action, and in promoting liaison between service providers.Voluntary bodies might also act as the voice of evacuees, as the WVS had notably done in autumn 1941. The organisation had initially met, and ‘to some degree engendered, a great deal of opposition from old established voluntary societies and some local councils’.53 It had, in other words, shown up the passiveness, and unwillingness to adapt, in parts of both the public and the voluntary sectors. A recent historian of the WVS, James Hinton, suggests that finding homes for evacuees ‘brought out the best and the worst’ of its leaders in rural areas, and Titmuss certainly provided evidence for such arguments.54 But he accorded organisations like the WVS considerable, if qualified, respect in his wartime history.This is both because they deserved it, and because the middle class WVS volunteers contributed to wartime social solidarity. In her letter, Lady Reading apologised for writing to Titmuss ‘out of the blue’, but she believed that ‘Solly Zuckerman may already have told you how much I would like to have an opportunity of talking with you’. Zuckerman, indirectly related to Lady Reading by marriage, was a prominent zoologist and government advisor. It seems likely that he knew Titmuss through the latter route, although he had also had contact with the Eugenics Society in the 1930s. Lady Reading informed Titmuss that she had ‘read with so much interest “Problems of Social Policy” and there are obviously implications here which are tremendously important from the WVS point of view’. In reply, Titmuss told her that he had already informed Zuckerman that he was happy to meet her, and was ‘naturally anxious to know what you think of my “Problems of Social Policy” ’.55 This exchange again reveals how well regarded Titmuss now was, and the circles in which he moved. While no record of the actual meeting appears to exist, judging by the tone

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of the correspondence there is no reason to think that it would have been anything other than amicable and constructive.

The volume’s reception For the most part, Problems of Social Policy was favourably received, and not only by Lady Reading. The anonymous review in The Manchester Guardian, to which Titmuss alluded, was entitled ‘The War and the Civilian: Creation of the Welfare State’, a conjunction which neatly sums up the volume’s argument. Titmuss had produced a ‘fascinating book which deserves wide attention’, and was far more than simply an account of official policy. It was also ‘a study of the background of present-​day politics’. How many in America, or Britain for that matter, realised that the ‘present “Welfare State” ’ was ‘the outcome of the years of stress. It was in a real sense the creation of the German bombers and not of theoretical planners’. Summing up, the piece noted, again acutely,‘Mr Titmuss’s judicious appraisal of the two sides of the national balance sheet’. On the one hand there was, for instance, ‘the maintenance of a fair degree of health … and the community spirit’. On the other, though, problems included ‘the temporary weakening of the family … and the slow recovery of the social services’.56 T.H. Marshall, by the time his review appeared an LSE colleague of Titmuss’s and among those who had supported his appointment, acknowledged the book’s ‘exceptional merits’. He also defended the writing of history while it was actually happening because the volume was full of ‘enlightening comments which could only be made by someone with direct personal knowledge of the situation’, assisted by ‘others whose experiences will never be recorded’. There were shortcomings. The title was misleading, as the text dealt only with ‘social problems directly created by enemy action  –​or in fact one can be more precise and say by air raids’. Evacuation, and the medical treatment of air raid casualties, were the main areas covered. It was, moreover, ‘easier to see what the machine did than what it was’, by which Marshall presumably meant the actual workings of the administrative process. Nonetheless, the ‘historical problem most clearly in Prof Titmuss’s mind’ was the impact of the ‘war experience on the development of the social services and the evolution of the Welfare State’. Here Marshall found Titmuss both ‘subtle and profound’, especially in his analysis of the ‘spur given to the planning of a National Health Service’ by the clash between public sector and voluntary hospitals. The latter were institutions dependent on fees, charitable donations, or subscriptions, and were abolished by the NHS. Titmuss had, Marshall

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remarked, ‘some bitter things to say’ about them. More generally, the attitude of social service providers had changed, not least because war ‘largely eliminates the class element from social service’.57 The book was also noticed in the US. George Rosen, a leading figure in American public health, and effectively founder of the social history of medicine, described Titmuss as a ‘well known British social scientist’ who had done an ‘exceedingly competent job’ in producing a work ‘also full of human interest’. It was ‘must reading for all public health workers, both as professional persons and as citizens’.58 Without over-​ reading these comments, it is revealing that Titmuss’s work should be deemed interesting to American readers. Back in Britain, the publisher, Freddy Warburg, congratulated Titmuss on the book’s ‘magnificent press’. Titmuss should feel ‘pretty proud of the work you have done, which must have been long and intensive’. Warburg wanted to know Titmuss’s plans –​this was a few months before his LSE appointment –​ and suggested meeting to discuss whatever he might next want to write about.59 While nothing seems to have come of this, it does further indicate the interest stimulated by Problems of Social Policy. Less positively, at least for Titmuss, his book also prompted a letter from G.E. Haynes, General Secretary of the National Council of Social Service. The two had lunch scheduled at the Athenaeum, and Haynes wanted to alert Titmuss to an issue he especially wanted to discuss.The Council was ‘beginning, alas!, to prepare our part in the Civil Defence programme. I would like your reactions very much in view of your most admirable study of the position during the last war’.60 The 1948 Civil Defence Act had established the Civil Defence Corps, a voluntary body whose duty would be to support rescue services during a national emergency. Given that by the early 1950s the Cold War was under way, essentially this meant an attack by the Soviet Union. Britain was not the only country making such plans. The day after Haynes’s letter,Titmuss received another, this time from someone who was to be a long-​term correspondent, John Morgan at the University of Toronto. Morgan enclosed copies of an article he had written for the Canadian Welfare Council’s journal, subsequently more widely circulated in print and through talks by Morgan, which had been based on Problems of Social Policy. Canadian Civil Defence Planning, he told Titmuss, had until now been almost entirely in the hands of the military, with little account being taken of welfare issues. Morgan concluded with the more welcome news that ‘I believe a substantial number of copies of your book will now have been ordered by Public authorities in order that they may study the problem. I hope this may make some contribution to the dollar problem’.61 In response,Titmuss, entering into the

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spirit of Morgan’s joke about Britain’s challenging financial position, suggested that ‘HM Government will, I am sure, be glad to know that a few more dollars are coming in!’ It was, though, shocking to think that the machinery of civil defence was being re-​established. He had recently met with Haynes, who had sought advice about ‘possible civil defence functions for the Council and about what steps they might usefully take in advance of an “emergency” (that awful word again!). I found it hard to give him helpful advice’.62 It is ironic that Titmuss’s volume, which drew positive messages from the Second World War experience, was seen as offering guidance on how to prepare for another conflict.

Rethinking Problems of Social Policy Titmuss’s book had a huge impact on academic interpretations of Britain on the Home Front, as well as on popular perceptions (many of which persist into the twenty-​first century).63 Some 15  years after his review, Marshall claimed, in his famous text on social policy, that ‘Britain’s experience in the war was unique’, and, given the circumstances under which it was fought, this explained why ‘the concept of the Welfare State first took shape in England [sic]’. The scale of the conflict, and the country’s vulnerability to attack, required ‘sacrifices from all and equally for help given ungrudgingly and without discrimination to all who were in need’. The source for these claims was Problems of Social Policy.64 Titmuss himself repeatedly returned to the relationship between war and social reform. In his contribution to a series of lectures on ‘War and Society’ in the mid-​1950s, later reprinted in Essays on ‘The Welfare State’, he started with the claim that little historical research had been done on war’s social and economic impact on whole populations, following this with a wide-​ranging survey going back to the ancient Greeks (and including the purported lack of attention in Jane Austen’s novels to the Napoleonic Wars). He then turned to war and social policy, noting that this relationship had developed in three stages: first because of concerns about the quantity of military recruits, second because of concerns about the quality of potential military recruits, and third through a broader concern with population health, and especially that of children, ‘the next generation of recruits’. Overall, this manifested ‘the increasing concern of the State in time of war with the biological characteristics of its people’. Hence the ‘waging of modern war presupposes and imposes a great increase in social discipline’, tolerable only if ‘social inequalities are not intolerable’. Only then would the ‘co-​operation of the masses’ be won. War and social policy thus

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had profound reciprocal influences. Titmuss conceded that this was not ‘the whole story in the evolution of social policy’, although he saw this last point as underpinned by faith more than by reason.65 This opaque caveat seems to imply that however much one paid lip service to other factors, war remained the locomotive of social advance. Harris suggests that here Titmuss is shown more as a ‘didactic social theorist’, in contrast to the ‘subtle and finely nuanced social historian’ evident in Problems of Social Policy.66 While overplaying the contrast between the two works, this makes an important point. Nonetheless, by the time of his speech Titmuss was convinced that his version of the origins of post-​war reconstruction was historically accurate. In a lecture on ‘The Social Services’ in the early 1950s, Titmuss agreed that the Beveridge Report had given ‘rational expression to shared experiences and aspirations during the war’. In turn, this meant that the war, characterised by social solidarity and cohesion, had ‘effectively crystallised the demand for services open to all citizens, and good enough for all, without distinction of class’. Poor services were thus ‘inconsistent with the principle of universal “fair shares” on which the war was being fought’. But these ideas and attitudes had very specific origins. The ‘welfare state’ therefore ‘began not with the Beveridge Report, but when the last troops left the beaches in May, 1940, and Britain stood alone against the forces of Nazi Germany’.67 Not everyone accepts Titmuss’s analysis, however. Another early review of Problems of Social Policy came from the distinguished historian of Britain, C.L. Mowat. Mowat found it an ‘admirable work’, paying due attention especially to the Blitz and evacuation. Significantly, though, he argued that the foundations of the ‘welfare state’ had been laid well before 1939, albeit that the war had highlighted the need for social reconstruction.68 Some 40 years later, Jose Harris, reviewing the war on the Home Front and the contribution of Titmuss’s history to its understanding, commended her former doctoral supervisor as ‘still perhaps the most influential and imaginatively compelling historian of the domestic and civilian theatre of war’. But she questioned a number of his premises, remarking, for example, that some of the policies described by Titmuss as deriving directly from the ‘Dunkirk spirit’ had more complicated, less solidaristic, origins. A case in point was family allowances, which ‘Titmuss had portrayed as one of the direct practical outcomes of the Dunkirk spirit’, but was in fact the result of various trade-​offs between government departments.69 Others have made similar points. Bernard Harris acknowledges the expansion of school meals provision during the war, while commenting

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that Titmuss ‘almost certainly exaggerated the humanitarian “generosity” in the development of the service’. Harris also remarks that by 1945 around one third of elementary school children and one half of secondary school children were receiving meals.70 Impressive as this expanded service was, it is some way from the ‘social service’Titmuss claimed it to be. At a more abstract level, Jose Harris points to the uncritical notion of ‘Britishness’ employed in the Civil Histories. In the particular case of Titmuss, he found underlying the operations of wartime social policy ‘a more intangible national identity and national will’.71 Problematic as this undoubtedly is, it nonetheless points to Titmuss’s English patriotism. More generally, while participation in wars can have an impact on social policy (and, Titmuss insisted, vice versa), it cannot simply be a sole explanatory factor. Sweden’s emerging ‘welfare state’, a product of the 1930s and of which Titmuss was surely aware, is not explained by invoking war. And while popular demand for post-​war social reconstruction did mount in the last few years of the war, this was, Ross McKibbin suggests, as much due to rapid changes in British politics, and the extraordinary reception of the Beveridge Report, as with processes such as evacuation.72 In another recent analysis, David Edgerton argues that Titmuss’s account of the creation of the ‘welfare state’ continues to structure contemporary narratives.73 This is overstated, at least with regard to academic historians, although it is certainly true that varying interpretations of the origins of the ‘welfare state’ are available. But Edgerton has a point with respect to popular perceptions of modern British history, wherein it remains a commonplace that the ‘welfare state’ was an outcome of the Second World War. Problems of Social Policy remains an important contribution to our understanding of the Second World War and its aftermath. But its arguments do need to be treated with caution in the light of historical research, especially over the last half century. Titmuss’s interpretation should be seen for what it is –​a product of its time, when ‘progressives’ were hopeful that a new society could be constructed in the wake of a devastating conflict. For instance, in the same year as Titmuss’s volume appeared,T.H. Marshall published his own work outlining, as he saw it, British society’s progression from civil, to political, to social rights, the last embodied in the post-​war ‘welfare state’.74 Equally, it is significant that the hard questioning of Titmuss’s interpretation began in the last quarter of the twentieth century, an era of welfare retrenchment, and one where the post-​war consensus, if it existed in the first place, was well and truly over. Not by coincidence, by this point, too, the Titmuss ‘paradigm’ itself was coming under severe scrutiny.As is often remarked,

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the questions historians (including Titmuss) ask are shaped by the era in which they themselves live.

Firewatching The Blitz, for Titmuss a key moment of the Second World War, involved the predominantly night-​time bombing of Britain’s major urban areas. It started in autumn 1940, following the Luftwaffe’s failure to capture control of the skies during the Battle of Britain, and continued until spring 1941. The campaign sought both to cause economic damage, and to undermine civilian morale. Titmuss gives a vivid account of the assault’s impact on London in c­hapter  14 of Problems of Social Policy, noting that, at least initially, it caused ‘muddle and confusion’ among the authorities.75 However, while immense devastation was caused, the economy survived, and civilian morale held up. Although the Blitz ended in 1941, concerns about renewed aerial attack meant that civil defence measures remained in place, and were most notably called upon when, towards the end of the conflict, Germany targeted London with missiles and rockets. Titmuss played a part in civil defence, although after the first aerial assault had done its worst.Along with some 300 other ‘night volunteers’ over the course of the war, he was a firewatcher at St Paul’s Cathedral. Others performing this role included Hancock, and two other historians, H.J. Habakkuk and W.N. Medlicott, the latter becoming Titmuss’s colleague in 1953. As relief from their stressful and tiring duties, coming as they did for many on top of demanding daytime jobs, night volunteers could attend, a history of St Paul’s records, ‘lectures delivered by Members of the Watch to their colleagues, to alleviate the monotony of the nightly exercises’.These included Medlicott on economic warfare and, perhaps less enticingly, a talk entitled ‘Aluminium’.76 In a letter published shortly after Titmuss’s death, Hancock described how from ‘early in 1942 until the end of the war’ Titmuss did ‘duty every Wednesday night as a member of St Paul’s Watch’. His colleagues ‘respected his skill with the firehose and loved him as a man’. And, in that much-​repeated depiction, Hancock suggested that to some of his fellow volunteers Titmuss ‘was known as El Greco, in view of the resemblance that they saw in him to the elongated saints of that great painter’.77 In less elevated language, although showing a sense of solidarity among the firewatchers, a few months after the war’s end ‘Titters’ was invited to a party for St Paul’s volunteers.78 Titmuss was, in fact, rather late in joining the firewatchers. From January 1941 it had been compulsory for all those not involved in

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work of national importance.79 In Titmuss’s case, he may originally have been exempted either because of his employment with the County Fire Office or by the various government departments with which he was by then involved. In any event, he spent just over 50 hours per month guarding St Paul’s. Writing to Kay in 1944, he described the impact of Germany’s new terror weapon, the V1 flying bomb, colloquially known as the ‘doodlebug’. Titmuss had had a ‘grandstand view’ of one of these from the cathedral’s roof. It had flown above the dome before its engine cut out, then exploding in the Hatton Garden area. Titmuss had clearly had a good sight of this terrifying weapon, describing it as ‘Fearsome’. The following week, in another letter to Kay, he noted that evacuation following the renewed aerial assault had resulted in more evacuees from London than during the first Blitz, and that, partly in consequence, London was getting ‘appreciably emptier’. A few days later, in a further letter to his wife, he recorded that 59 flying bombs had passed over or close to the cathedral, a new record.80 The impact of these new weapons was more formally recorded in Problems of Social Policy, where it was noted that, for instance, procedures such as evacuation operated better in this period than earlier in the war.81

Conclusion Producing Problems of Social Policy proved a demanding task, but Titmuss rose to the challenge. In so doing, he constructed a narrative about the Home Front which became highly influential. For Titmuss himself, what he saw as the social cohesion and solidarities of wartime Britain became a framework for his understanding of what might be achieved, but whose legacy had not been properly fulfilled. Indeed, for some of his later critics, Titmuss was more at home in the 1940s than in the ‘Affluent Society’ which emerged in the 1950s and 1960s. As ever with Titmuss, his work in the 1940s consumed him. The next three chapters deal with some of his other activities, undertaken alongside the monumental project of writing his wartime history. Notes 1 2 3 4

R.H.Tawney, Land and Labour in China, London, George Allen and Unwin, 1932, pp 140–​60. I am grateful to Professor Ann Oakley for alerting me to this work. TITMUSS/​ADD/​1/​18, letter, 15 January 1951, RMT to A.A. Blytheway, Ministry of Labour and National Service. TITMUSS/​7/​59, letter, 7 December 1951, RMT to Carr-​Saunders. TITMUSS/​ADD/​1/​18, letter, 21 July 1952, RMT to Richard Hammond, Ministry of Food.

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RICHARD TITMUSS 5 K. Hancock,‘Preface’, in S. Ferguson and H. Fitzgerald, Studies in the Social Services, London, HMSO, 1954. 6 This paragraph draws on Oakley, Man and Wife; and J. Harris,‘Thucydides Amongst the Mandarins: Hancock and the World War II Civil Histories’, in D.A. Low (ed), Keith Hancock: The Legacies of an Historian, Carlton South, Melbourne University Press, 2001, pp 122–​48. 7 TITMUSS/​7/​44, memorandum, 3 June 1944, Hancock to ‘Mr Titmuss, Mr Davidson, Mr Wormald’. 8 TITMUSS/​7/​44, Hancock,‘Circular to Historians’, 27 November 1945, p 1 and passim. 9 W.K. Hancock, ‘Preface’, in W.K. Hancock and M. Gowing, British War Economy, London, HMSO, 1949, pp x, xi–​xii, xiii. 10 Harris, ‘Thucydides’, p 131. 11 TITMUSS/​7/​44, letter, ? November 1943, RMT to Hancock; R.M. Titmuss, ‘Recent German Vital Statistics’, Lancet, 1942, II, p 434. 12 A. Oakley, ‘Legacies of Altruism Richard Titmuss, Marie Meinhardt, and Health Policy Research in the 1940s’, Social Policy and Society, 18, 3, 2019, pp 385–​6. 13 F. Grundy and R.M. Titmuss, Report on Luton, Luton, The Leagrave Press, 1945, pp 139, 24–​5. 14 TITMUSS/​7/​44, letter, 25 February 1944, RMT to Hancock. 15 TITMUSS/​7/​44, letter, 10 October 1944, Hancock to Wrigley. 16 Titmuss, Problems of Social Policy, p xi. 17 TITMUSS/​ADD/​1/​30, letter, 16 November 1949, RMT to Acheson. 18 TITMUSS/​ADD/​1/​18, letter, 21 November 1950, RMT to Acheson. 19 TITMUSS/​ADD/​1/​18, letter, 1 December 1950, Acheson to RMT. 20 Harris, ‘Thucydides’, p 123. 21 TITMUSS/​7/​44, memorandum, 12 November 1945, Brook to Hancock. 22 TITMUSS/​7/​44, memorandum, undated but early 1948,‘Official Histories: Mr Titmuss’Volumes on “Social Policy”. Comments by Sir Norman Brook’, p 1 and passim. 23 TITMUSS/​7/​44, memorandum, 29 April 1948, ‘P.D.P.’, Treasury, ‘Outline of Social Policy’, pp 1–​2. It is unclear to whom this was addressed. 24 TITMUSS/​7/​44, memorandum, 21 April 1948, RMT to Brook. 25 TITMUSS/​7/​44, memorandum, 13 July 1948, RMT to Acheson. 26 TITMUSS/​7/​44, letter, 7 August 1948, RMT to Hancock. 27 TITMUSS/​ADD/​1/​33, letter, 25 March 1949, Hancock to Brook. 28 Harris, ‘Thucydides’, p 136. 29 TITMUSS/​ADD/​1/​33, letter, 18 July 1949, Acheson to RMT. 30 TITMUSS/​ADD/​1/​33, letter, 21 July 1949, RMT to Hancock. 31 TITMUSS/​7/​44, letter, 5 December 1943, Powicke to Hancock. 32 TITMUSS/​7/​44, letter, 5 February 1946, Glover to RMT. 33 TITMUSS/​7/​44, letter, 12 May 1947, Auckland to RMT. 34 TITMUSS/​7/​44, letter, 8 April 1949, Maud to Brook. 35 TITMUSS/​7/​58, letter, 21 March 1950, RMT to S.C. Leslie, Economic Information Unit, The Treasury. 36 TITMUSS/​7/​54, letter, 22 January 1946, Postan to RMT; and letter, 4 February 1946, RMT to Postan. 37 J. Welshman, ‘The Unknown Titmuss’, Journal of Social Policy, 33, 2, 2004, p 232. 38 Titmuss, Problems of Social Policy, pp ix–​xi.

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Problems of Social Policy: researching and firewatching 39 R.H. Tawney, ‘The Study of Economic History’, Economica, 39, 1, 1933, pp 9, 10, 15. 40 Titmuss, Problems of Social Policy, pp 506–​8, 510, 515, 521–​2, 532, 508. 41 ALLEN, MSS.121/​CC/​3/​3/​25, letter, 31 August 1944, RMT to Allen; and MSS.121/​CC/​3/​1/​56, letter, 18 September 1944, RMT to Allen. 42 D. Ritschel, ‘Next Five Years Group’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 43 Marjory Allen, letter, The Times, 15 July 1944, p 5. 44 TITMUSS/​7/​44, RMT notes ‘Talk with Lady Allen on 29th September 1944’, p 1. 45 ALLEN, MSS.121/​CC/​3/​3/​29, letter, 13 February 1945, RMT to Allen (emphasis in the original). 46 ALLEN, MSS121/​CC/​3/​3/​28, letter, 4 January 1945, Allen to RMT. 47 ALLEN, MSS.121/​CC/​3/​3/​31, letter, 7 March 1945, Allen to RMT, and MSS.121/​CC/​3/​3/​32, RMT to  Allen. 48 ALLEN, MSS.121/​CC/​3/​3/​33, letter, 28 May 1945, Allen to RMT. 49 ALLEN, MSS.121/​CC/​3/​3/​34, letter, 13 June 1945, Allen to RMT. 50 TITMUSS/​7/​56, letter, undated but spring 1948, Allen to RMT. 51 Lady Allen of Hurtwood, ‘The Children Bill:  Providing Home Life for the Homeless’, The Times, 7 May 1948, p 5. 52 Titmuss, Problems of Social Policy, p 391 and note 5, p 169 and note 2. 53 Ibid, pp 169, 229 note 3, 266, 267, 299. 54 J. Hinton, Women, Social Leadership, and the Second World War: Continuities of Class, Oxford, Oxford University Press, 2002, p 152. 55 TITMUSS/​7/​58, letter, 1 August 1950, Reading to RMT; and letter, 10 August 1950, RMT to Reading. 56 ‘The War and the Civilian: Creation of the Welfare State’, The Manchester Guardian, 20 March 1950, p 6. 57 T.H. Marshall, ‘Wartime Social Policy’, Economic History Review, 4, 2, 1951, pp  263–​6. 58 G. Rosen, American Journal of Public Health, 41, June 1951, pp 733–​4. 59 TITMUSS/​7/​58, letter, 20 April 1950, Freddy Warburg, Martin Secker and Warburg, to RMT. 60 TITMUSS/​7/​59, letter, 16 January 1951, Haynes to RMT. 61 TITMUSS/​7/​59, letter, 17 January 1951, Morgan to RMT. 62 TITMUSS/​7/​59, letter, 8 February 1951, RMT to Morgan. 63 Although Harris suggests that the influence was probably by way of a process of diffusion, rather than direct: ‘Thucydides’, p 141. 64 Marshall, Social Policy, pp 75, 7. 65 R.M. Titmuss, ‘War and Social Policy’, in Essays on ‘The Welfare State’, London, George Allen and Unwin, 3rd edn 1976, pp 75, 76–​7, 78–​81, 85–​7. 66 J. Harris,‘War and Social History: Britain and the Home Front during the Second World War’, Contemporary European History, 1, 1, 1992, p 31, n 43. 67 TITMUSS/​2/​163, typescript ‘The Social Services’, nd but first half of the 1950s, pp 8, 1. 68 C.L. Mowat, ‘The Approach to the Welfare State in Great Britain’, The American Historical Review, 58, 1, 1952, pp 61–​2. 69 Harris, ‘War and Social History’ pp 18, 31ff. 70 B. Harris, The Health of the Schoolchild: A History of the School Medical Service in England and Wales, Buckingham, Open University Press, 1995, p 156.

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RICHARD TITMUSS 71 Harris, ‘Thucydides’, p 141. 72 R. McKibbin, Parties and People: England 1914–​1951, Oxford, Oxford University Press, 2010, p 123ff. 73 D. Edgerton, The Rise and Fall of the British Nation: A Twentieth Century History, London, Allen Lane, 2018, p 223. 74 T.H. Marshall, Citizenship and Social Class and Other Essays, Cambridge, Cambridge University Press, 1950. 75 Titmuss, Problems of Social Policy, p 257. 76 W.R. Matthews, St Paul’s Cathedral in Wartime, London, Hutchison, 1946, Appendices 1 and 3. Appendix 2 gives an account of a typical night’s work. 77 Sir K. Hancock, ‘Richard Titmuss’, letter to The Times, 15 May 1973, p 18. 78 TITMUSS/​7/​53, letter, 13 September 1945, A.S.G. Butler to RMT. 79 D.Todman, Britain’s War: Into Battle 1937–​1941, London,Allen Lane, 2016, p 512. 80 Oakley, Man and Wife, p 150, cited p 234, cited p 241, cited p 251. 81 Titmuss, Problems of Social Policy, p 323.

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7 Titmuss and the Eugenics Society in war Introduction In the course of the 1940s, Titmuss continued to play an active part in the Eugenics Society which, as we saw in Chapter 4, he had joined in the late 1930s. This was prompted by his interest in population and population health. But it likewise afforded him the opportunity to network with well-​connected individuals who were to become important figures in promoting his career, such as Carr-​Saunders and Hubback.This chapter examines Titmuss’s work for the Society during the Second World War, especially from early 1942. He was editor of Eugenics Review for the first two editions of that year, standing in for Maurice Newfield while he was unwell. From the outbreak to the end of the war he also contributed six articles and a number of book reviews to the journal, as well as taking to task, in the correspondence columns and in debate, critics of his own approach to population issues. He participated in Society meetings, during the early part of the war was on its Emergency Committee, and by the end he was on its council, the latter an elected position. Titmuss published his third book, Birth, Poverty and Wealth: A Study of Infant Mortality, with Eugenics Society support. He was also co-​opted, in 1943, onto the Population Investigation Committee (PIC), set up by the Eugenics Society in the mid-​1930s.

Committee man, editor, and contributor With the outbreak of war one immediate consequence for the Eugenics Society was that C.P. Blacker was called up to the Royal Army Medical Corps (RAMC), so depriving the organisation of one

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of its most active members and administrators. An emergency meeting of the council was called shortly afterwards. It was agreed to set up an Emergency Committee, chaired by Lord Horder, of ‘nine members able to attend regularly, with power to co-​opt’, which would ‘act on behalf of Council for the duration of the war’. Titmuss was one of these, as were Carr-​Saunders and Hubback.1 He was undoubtedly in favour of the creation of the Emergency Committee, telling Ursula Grant-​Duff in mid-​September that there was an overriding need to ‘see that the work of the Eugenics Society is kept alive’.2 And as we saw in Chapter 4, he was soon in demand as a source of information, being requested to provide the next meeting of the Emergency Committee with proposals for children’s allowances, and his findings on the physical condition of the army. Titmuss was clearly becoming an active figure in the Society, something further recognised by his membership of the Homes in Canada Service Committee. This small body originated when the Society’s Canadian sister organisation offered to receive child evacuees. It was to identify ‘certain eugenically important groups’ not presently covered by the British government’s own overseas evacuation scheme.An example of such a neglected group would be children who had won scholarships to non-​grant-​aided schools (that is, not a ‘traditional’ grammar school), and the criteria for selection were ‘intelligence, good heredity and good health’. A panel of doctors had been approved by the Homes in Canada Service Committee to apply these ‘fundamental eugenic safeguards’. Superficially, it seems surprising that Titmuss should have become associated with such an apparently conservative eugenic project. However, it was also explained that the committee had ‘resolved … that poverty alone will in no case be allowed to stand in the way of any parent who wished to take advantage of Canadian hospitality’. Clearly sensitive about this issue, it was further stressed that the Eugenics Society had established a fund, for which it was also issuing an appeal, so that ‘none of the selected children should be kept back by reason of poverty’.3 It seems likely that Titmuss had some say in this formulation, and it is notable that the committee was chaired by another reform eugenicist, C.F. Chance. To put it another way, the notion that a child from a poor background could nonetheless be intelligent would have run counter to the sort of eugenics decried by Titmuss. Titmuss continued to play his part in the administration of the Eugenics Society, for example being re-​elected to the revived council in May 1945. Among his fellow councillors were a number of individuals who had played, or would play, a part in his life, including L.J. Cadbury, Carr-​Saunders, Grant-​Duff, the demographer David Glass, and the

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eminent biologist Julian Huxley.4 But we now turn to his more public work on the Society’s behalf, starting with his temporary editorship of Eugenics Review. This began in autumn 1941, with Titmuss taking over for the editions of January and April 1942.5 Finding someone to take on this sort of onerous task in wartime would have been problematical for any organisation, so that he stepped forward is indicative of Titmuss’s commitment to the Eugenics Society. It was not, after all, as if he had nothing else to do. Titmuss used his editorial platform to revisit some of his preoccupations. In the January edition, for instance, he noted the startling decline in the German birth rate, claiming that such a ‘large decrease can hardly be interpreted by the Nazis as an encouraging feature’. It was a ‘vote of No Confidence’ in the regime, its various exhortations to the German population to reproduce notwithstanding. He also noted that the Eugenics Society, and he might also have cited himself here, had consistently argued for better quality data on British population trends, and that ‘after a stern battle with the powers of obscurantism’ the Population (Statistics) Act had been passed in 1938. The war had, without due cause, delayed the publication of up-​to-​date material. Citing the recent work by the Swedish social scientist Gunnar Myrdal, Titmuss continued that Britain would soon be ‘faced with a population crisis’ and the sooner ‘adequate statistics on current fertility patterns and other factors’ were provided, the sooner a ‘eugenic approach to the problem of man’s continuing refusal to reproduce’ could be formulated.6 In the April edition, meanwhile, Titmuss noted the limited publication of the Registrar General’s review of 1938, a year which for ‘students of population’ marked ‘the end of an epoch’. It was the last ‘in which the forces of life and death were undisturbed by war’, and the first since 1911 when comprehensive data became available for the analysis of fertility by way of the 1938 Act. Titmuss then gave a summary of this material while referring readers to his own article in the same edition, discussed later.The other issue with which this engaged was, in the wake of a memorandum produced by the Chancellor of the Exchequer, family allowances.This was primarily a technical document to do with costings, giving no sense of whether or not the government was inclined to introduce such a measure. Without attributing the quote of which he clearly approved,Titmuss finished with the view of ‘one commentator’: that ‘the food, the clothing, the cots, the nursery accommodation represented by this or that sum of money socially desirable –​and who doubts that they are –​the millions given to the families is simply facilitating the distribution of the socially desirable goods to the people socially most eligible for them’.7

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Titmuss also contributed to Eugenics Review as an author, for example with an important article,‘Eugenics and Poverty’, co-​written with François Lafitte and published in January 1942. This was partly concerned with the impact of the socioeconomic environment on individual and collective health, an approach central to social medicine. However, it also had more general, but equally important, things to say about eugenics, its philosophical underpinnings, and its aspirations. For Titmuss and Lafitte, eugenics was the ‘use of scientific means to attain an ethical end’, the latter being a ‘higher level of mental and physical health’ and ‘an increase in the biological efficiency of human beings’. ‘Eugenists [sic]’ sought a ‘higher level of health –​ie of “wholeness” ’ as an end in itself for ‘the human personality is an end in itself ’, and because they wished to see ‘human beings in the mass become more completely human’. The Nazis, by contrast, were interested in human health, and biological efficiency, ‘only to the extent that they further the immoral purposes of a tyranny whose highest aim is total warfare’. An individual’s genetic endowment, moreover, did not of itself ‘suffice to produce “whole” human beings’. Even those with a good genetic inheritance required a ‘healthy environment’. This embraced factors such as economic opportunities and the ‘psychological and moral atmosphere’. Only then could an individual attain the ‘full mental and physical stature of a “whole” adult’ potentially available to all human beings. Crucially, though, so entangled were the ‘factors of “nature” and “nurture” of which each human being is the end-​product’, and so ‘scanty still’ was knowledge of human genetics, ‘that no eugenist can afford to neglect the study of environmental factors –​especially of social and economic conditions’. The authors examined the evidence of various social and health surveys.They concluded that while on one level social progress had taken place, the poorest in society were ‘relatively worse off to-​day than forty years ago’. The ‘flight from parenthood’, and its implications for the size and structure of future populations, were likewise noted.8 All these were ideas which Titmuss had been propagating since the 1930s. Three particular points stand out here. First, the notion that eugenicists should take account of environmental factors was provocative, for this was exactly what the movement’s conservatives had argued against from the outset. That they still had influence was indicated by, for example, the Eugenics Society’s debate over the Beveridge Report. Here, Titmuss took other speakers to task for focusing on a tiny minority of the population, the so-​called ‘social problem group’, and neglecting the bulk of the population who would benefit by Beveridge’s proposals.9 Titmuss and Lafitte must therefore be seen as

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part of what Bland and Hall describe as an influential grouping within the Society, ‘growing throughout the 1930s under Blacker’s tenure as general secretary’, which constituted a ‘liberal/​leftist progressive tendency’. This group saw eugenics as part of a ‘wider vision of a scientific approach to the management of society as a whole’.10 It is, in this context, likewise notable that Titmuss and Lafitte emphasised the moral underpinnings of their ideas. Second, the emphasis on the ‘whole’ and ‘wholeness’ deserves comment, given its prominence in the article. It further reflects Titmuss’s adherence to a holistic, organic view of society which we have encountered on various occasions.The sort of holistic standpoint which Titmuss and Lafitte expressed was thus another example of the participation by such social commentators in a broader intellectual movement seeking to critique the perceived problems of modernity. For those on the progressive left, organic metaphors might be employed to ‘focus on self-​regulating equilibrium and solidarity’ among society’s constituent parts in order to ‘justify gradualism and piecemeal government interventions in social life’.11 As we saw in the last chapter, the wartime ‘solidarity’ of the British people was central to Problems of Social Policy, and to Titmuss’s aspirations for post-​war society. Third, there is the point about ‘total warfare’. By the time of the article’s publication, Britain had seen off the initial German threat. More than this, though, the Nazi regime had a few months earlier launched its assault on the Soviet Union, and the barbarity of the war on the Eastern Front was already evident. Small wonder that Titmuss and Lafitte distinguished sharply between what they meant by ‘eugenics’ and the immorality of the Nazi regime. Even more recently, Japan had attacked the US fleet at Pearl Harbor, followed by its successful assault on the British base at Singapore. So the war spread to the Far East, with Hitler making the conflict truly global by declaring war on America. Titmuss also wrote more specifically on population issues. In an April 1942 piece on the birth rate, he concluded that underneath the existing data there was a ‘serious and continuous fall in reproduction’, and that the ‘loss in unborn casualties to the end of 1941 exceeds by 100 per cent the number of civilians killed by enemy action from the air’.12 Titmuss returned to the subject the following year. Here he acknowledged an upward trend, something unexpected given ‘the known effects of previous wars on fertility’. But the rate had certainly fallen from 1939 to the end of 1941, potentially leading a decline to ‘an abnormally low level’. It might be assumed that this recent upswing would give Titmuss cause for hope, although this would have dented his previously unshakeable population pessimism. Not so. He instead

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finished his article by posing two questions. Did the upswing ‘herald a permanent change? Should we not rather say, after taking account of the remarkable combination of favourable influences, that the time of reproduction, which has been receding for over sixty years, has not yet turned?’13 Demographic gloom remained the order of the day.Titmuss also continued to review books for the journal, for instance Clarice Burns’s study of Durham, Infant and Maternal Mortality in Relation to Size of Family and Rapidity of Breeding. He found this flawed, especially on the impact of social factors, a subject close to his own heart, but ‘otherwise valuable’.14 As well as editorialising, writing, and reviewing for Eugenics Review, Titmuss contributed to Eugenics Society meetings. The following example illustrates this point and, once again, his wartime preoccupations. In autumn 1943 Titmuss received a letter from Blacker, now back from the army, working for the Ministry of Health, and soon to publish an important report on mental health services. Blacker was having problems organising the Members’ Meeting, scheduled for 16 November, and he asked Titmuss if he would be prepared to speak, possibly drawing on his recently published Birth, Poverty and Wealth. He would be grateful for anything Titmuss could do, as it was ‘not easy to get this Society going again properly’.15 Titmuss obliged. He delivered his talk, ‘Social Environment and Eugenics’, to the meeting chaired by Horder, with an abstract released to the press.16 And, as requested by Blacker, Titmuss’s address was duly published in Eugenics Review. Titmuss did draw on his recent publication, and also took the opportunity to give a historical account of the development of eugenics, and to use this to stress the importance of environment. He started by addressing the legacy of Francis Galton, cousin of Charles Darwin, founder of eugenics and strict hereditarian.17 Titmuss argued that it would be wrong to condemn Galton’s hereditarian analysis without understanding the context in which it was formulated. By the same token, however, those who held ‘strongly to-​day to the Galtonian viewpoint’ were ‘equally unjustified because they refuse to evaluate the social history of the last fifty years and because they ignore the immense advances made by the social sciences’. No doubt Titmuss counted himself, not unreasonably, as a contributor to social scientific knowledge. Despite a recent volume by Horder on ‘obscurantism’, there were still ‘too many obscurantists about’. Titmuss was clearly in no mood to pander to the Eugenics Society’s traditionalist and, as he saw it, reactionary elements. But he did not entirely dismiss hereditarian ideas. In a concluding passage which embraced a number of his concerns, Titmuss argued that if

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we wish to reap a richer harvest –​in terms of quality –​in the future, when the quantity of our population will be declining, then it is for us not to be content only with weeding out the demonstrably unfit; we must look equally to the improvement of the social environment.18

So in a situation of declining population, a central tenet of Titmuss’s beliefs at this point, the ‘demonstrably unfit’ needed ‘weeding out’. Titmuss gave no indication of who these might be, and who might make decisions about them, on one level a classic example of traditional eugenicist value judgement. On another, though, the need to improve the social environment was unequivocally reasserted.

Birth, Poverty and Wealth Many of these issues were addressed in Birth, Poverty and Wealth: A Study of Infant Mortality, which came out in 1943. Prior to publication,Titmuss circulated a draft to leading Eugenics Society members Blacker, Newfield, and Byrom Bramwell, chair of council, and possibly others. In a letter to Bramwell, Blacker remarked of Titmuss’s manuscript that he had been impressed with its argument, and its presentation of statistical material. He agreed with Bramwell, who clearly had also read and commented on the draft, that ‘political’ commentary should be reduced, as the ‘left-​wing humanitarians and professional idealists will provide as much of that as we are likely to want’. On the same day, Blacker also wrote to Newfield, noting that the book was ‘original and important’, that he approved of the Society’s financial support, and equally of the decision to keep this quiet for the moment. ‘You and I’, he continued, ‘think that it would be a eugenically desirable thing to reduce or abolish the gradient of inequality.’ But this would not be the view of the older generation, still represented on the council.19 Newfield also provided the book’s introduction. Editor of Eugenics Review from the early 1930s, Newfield was reform minded, described himself as a ‘liberal socialist’, and sought to transform the Review from a journal speaking to the converted to one which embraced debates on issues such as birth control.20 Newfield duly praised Titmuss’s diligence, and suggested that the chances of survival, and healthy subsequent development, for any new-​born child depended ‘of course on his congenital equipment’. But he immediately added the important rider, ‘but only in part’. To a ‘very large measure’ survival and development relied, too, on ‘such external influences as the wealth of his parents and their capacity to

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take advantage of the medical knowledge and social services available for his welfare’.21 In his acknowledgements,Titmuss thanked Morris, Newfield, and the psychiatrist and Society member Aubrey Lewis for their input. He also thanked the Leverhulme Trust and the Council of the Eugenics Society for the grants they had awarded, while stressing that these bodies, and his colleagues, were not ‘in any way committed to my conclusions. For these and for the collation of the data from which they are derived I take the full responsibility myself ’.22 Titmuss was being cautious here as he knew, as Blacker had suggested to Newfield, that his arguments would not appeal to more ‘traditional’ eugenicists for whom heredity was all. The Society grant was, meanwhile, effectively a subsidy to the book’s publishers, Hamish Hamilton. Blacker grumbled to Titmuss that the Eugenics Society had not received any review copies of his work, and that ‘our subsidy of £100 was, in the event, a gift to HH’. All in all, the publishers had shown ‘either carelessness or discourtesy to the society’.23 In fact, and as Blacker almost certainly knew, having such a work published without some form of subvention would have been difficult, especially in wartime. So what arguments did Titmuss put forward? In a sense, the title says it all. Infant mortality was now, as it always had been, ‘a broad reflection of the degree of civilisation attained by any given community’. Carefully laying out his data, Titmuss then addressed the view that extreme contrasts in infant mortality were the ‘outward and inevitable expression of a defective genetic constitution’. The evidence did not support this analysis, however, and so ‘we are left with environment, in the widest sense of the term, as the greater determinant’ of differential rates. Such an approach was backed up by, for example, recent advances in the social and medical sciences.Titmuss conceded that Britain’s infant mortality rate had declined, but noted, too, that it had done so to a much greater extent in other countries, such as Holland. Indeed the relatively poor data for Scotland was ‘sufficiently disturbing to warrant a full-​ length study’, with Glasgow singled out as a city which had performed extremely badly when compared to, among others, Chicago and Oslo. As to what caused all this, inequalities of income and wealth were the culprits. Not only were the poor more vulnerable to infant mortality, the situation had actually worsened, again a recurring theme in his work. For Titmuss, the ‘inescapable lesson’ of his study was that the ‘infants of the poor are relatively worse off to-​day than they were before the 1914 war’. British society was thus, notwithstanding increased social service expenditure, ‘further away from the goal of equalised health than we were thirty years ago’.Was it, therefore, too much to suggest that ‘if the

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gradient of economic inequality had become gentler with the years, a statistical study of infant mortality would have yielded results very different from those recorded in this book?’.24 Blacker’s observation about how this would be received by more conventional eugenicists is easy to understand in the light of such arguments. For such traditionalists there was, though, to be no respite. Reviewing the book in Eugenics Review, R.R. Kuczynski told its readers that it was a ‘brilliant study of infant mortality’. Summarising Titmuss’s work, Kuczynski noted the importance of social class, that the situation had actually deteriorated over the past few decades, and that other countries had performed better –​here he cited the author’s comparison of Glasgow with other cities. So it was ‘very much to be desired that the conclusions arrived at by Mr Titmuss be universally known’. Parliament, and the general public, were being ‘spoon-​fed with complacent statements about the allegedly extraordinary decrease in our infant mortality rate’, without acknowledgement of how much better results had been achieved elsewhere.25 The notice in The Times, meanwhile, was largely descriptive but broadly sympathetic, notably remarking that Titmuss’s findings were in ‘complete disagreement’ with Galton’s prioritising of nature over nurture.26 Kuczynski’s brother, Jürgen, was clearly also a fan. In his capacity as chair of a branch of the Association of Scientific Workers, he suggested a talk by Titmuss on the subject of his book.As the branch secretary told Titmuss, a large proportion of his membership was ‘drawn from the medical and allied sciences, and we feel sure that they would especially welcome the opportunity of taking part in the proposed meeting’.27 It is not clear whether Titmuss did talk to this body, his employment as a civil servant possibly preventing him from doing so, but the invitation indicates the sort of impact the book was having. His old political ally Richard Acland, meanwhile, wrote to ‘congratulate you on the amazing reviews you are getting for your book’ while conceding that he had not actually read it himself, a common enough fate for academic authors.28 Just how contentious the whole field of eugenics could be, though, is illustrated by Lancelot Hogben’s review. Hogben was a biologist who had been, at one point, Professor of Social Biology at the LSE, later becoming first editor of the British Journal of Social Medicine. He was famously combative, politically on the left, and notably hostile to eugenics on both methodological and social grounds.29 Hogben had, in addition, been one of the early, non-​Eugenics Society, members of the PIC.30 In his review, in the leading science journal Nature, Hogben attacked Galton, and his modern-​day followers. He berated the ‘combination of naivete and nonsense’ uttered by ‘reputedly competent

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men of science’ regarding the supposed predominance of nature over nurture. Such nonsense was ‘transparently belied’ by work on human nutrition and, in Titmuss’s case, on mortality data. Titmuss had made accessible in a ‘readable narrative facts too apt to remain buried in census volumes on the shelves of libraries’. His book was, therefore,‘a refreshing indication that there is a rising generation of statisticians and social biologists’ who had ‘thought their way through the luxuriant growth of misconceptions which Galton’s generation planted and Pearson’s followers watered’. Titmuss’s work was ‘temperate and stimulating, lucid and well-​documented’. He had raised problems which urgently needed addressing ‘above the fog of political indignation to the level of a factual analysis of human needs and human knowledge available for implementing their satisfaction’.As such, the book deserved ‘a wide circulation among those who cherish what Bacon called the true and rightful goal of science’.31 In private at least, Titmuss must have been delighted with such a glowing notice, in an important journal, from such a high-​profile scientist.The Eugenics Society was less impressed. In an editorial in Eugenics Review, Newfield acknowledged the positive aspects of Hogben’s review. All such praise was ‘well merited’, and it was gratifying that it was being used in material advertising the book. Nonetheless, Hogben had not only commended Titmuss, he had also, and not for the first time, launched his familiar attack on Galton. Consequently, Horder and Blacker had, on behalf of the Eugenics Society, written to the editor of Nature suggesting that Hogben was preoccupied with what eugenicists were saying 30 years earlier. Nor had it been acknowledged that Titmuss had been a member of the Society’s council for a number of years, had acted as editor of Eugenics Review, and that ‘the publication of his book was made possible by a grant from the Society –​a fact clearly acknowledged by the author in his preface’. Nature was, therefore, responsible for a false impression being created and, thereby, for its refutation. The letter, though, was not published on the basis that, as far as far as Nature was concerned, its content would serve no ‘useful purpose’.32 If nothing else, this episode illustrates Hogben’s ability to get under people’s skins and, by the same token, the Eugenics Society’s sensitivity to criticism concerning the nature/​nurture debate.

The Population Investigation Committee Titmuss was far from being alone in his concerns about population, and population health. A Royal Commission on Population was set up in 1944 by the coalition government’s Home Secretary, and former

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Labour leader of the LCC, Herbert Morrison, reporting in 1948. When Titmuss joined the PIC, in 1943, he told fellow member R.R. Kuczynski that he had recently been called to see Morrison’s private secretary, as ‘Herbert is going to make a speech about the birth rate’.33 This summons is yet another indicator of   Titmuss’s assumed authority in the field, although he was also, of course, by this point a government employee.Among the Royal Commission members well known to Titmuss were Carr-​Saunders, while witnesses included Blacker, Hubback, Glass, and Cyril Bibby, a regular contributor to Eugenics Review.34 A quarter of a century later, Bibby was to send Titmuss a letter of support during ‘The Troubles’ at the LSE. As Pat Thane notes, the Commission’s Report admitted concern about the birth rate, and recommended the expansion of certain welfare benefits and services. Ultimately, though, it ‘expressed some lasting fears but offered no solutions’.35 In any event, the post-​war ‘baby boom’ was to resolve at least the birth rate issue. The Population Investigation Committee was set up jointly by the Eugenics Society and PEP in the mid-​1930s, yet another manifestation of contemporary concern about population issues.After the war, it was absorbed by the LSE, and founded the journal Population Studies. The latter had Glass as its editor, and an advisory board on which Titmuss sat along with, among others, Kuczynski and T.H. Marshall.36 At various points the PIC received funding not only from the Eugenics Society, but also from the Carnegie Corporation and the Nuffield Foundation.37 As its longstanding chair, Carr-​Saunders, noted around the time of the committee’s creation, the Eugenics Society had been moved to set it up by ‘the fact that the population position in this country now presents, both from the quantitative and qualitative points of view, very serious and urgent problems’.38 As Chris Renwick points out, Carr-​Saunders was a key figure in the 1930s as a social scientist, and sought to promote a reform-​oriented eugenics, so edging it away from proposals associated with ‘negative’ eugenics such as sterilisation.39 His position as chair was, therefore, crucial. Among the early members of the committee were Marshall, Blacker, Hubback, and Huxley.40 The PIC’s activities were curtailed on the outbreak of war before being revived in 1943. This revival was, as Eugenics Review reported, in part prompted by Titmuss’s agitation on the Eugenics Society’s council in 1942, and facilitated by Blacker’s return from the RAMC. The Eugenics Society also granted £500 per annum for two years in support of the PIC’s activities.41 Titmuss, although not a member of this body until its reconstitution in 1943, when he was ‘elected by unanimous consent’, was nonetheless interested in its work from the outset, known to a number of its

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members, and prepared to send it suggestions for research. For example, in 1940 he reviewed Leybourne and White’s Education and the Birth Rate, a book resulting from two years of ‘intensive research sponsored by the Population Investigation Committee’ which brought together ‘for the first time a wealth of social statistics relating to the structure of the educational system in this country in its bearing upon family size’. One key finding was that there existed ‘enormous hidden reserves of intellectual capacity … among the children of the 60 per cent of income earners who receive on the average less than 60s a week’. As matters presently stood, such children could not realise their potential, something which was even more detrimental to society when it was acknowledged that this group would constitute ‘the bulk of our future population’. So it was in the 90 per cent of children currently attending state-​run elementary schools that the ‘national problems of quantity and quality lie’.42 Educational inequality, and the unused intellect of working class children, were ideas which Titmuss was to continue to pursue. Also the early 1940s, it was noted that ‘Mr R.M.Titmuss, while not a member of the Committee’, had written that there were ‘two short-​ term pieces of work which the Committee might investigate’ –​the incidence of first births, classified by factors such as regional and class differences, and problems of maternity in wartime.43 At the meeting at which he was admitted to membership, Titmuss argued that there was reason to believe that the policies now being considered by the Ministry of Health for post-​war housing ‘paid insufficient attention to demographic problems, in particular provision for large families’. After discussion, a housing subcommittee was duly formed consisting of Horder, Hubback, Glass, and Titmuss.44 Titmuss’s concern with housing and family size was not new. In his 1941 piece for Town and Country Planning, discussed in Chapter 5, he had argued the need for future housing plans to take family size into account. Titmuss began to play an active part in the PIC, especially on some of its committees. For instance, he sat on the General Purposes Sub-​ Committee which, in July 1943, set up another subcommittee, on maternity services and child welfare. Members included Titmuss, Glass, Hubback, Lafitte, and Blacker.45 At its first meeting, it was agreed that its work should take place in two phases:  first, a short-​term investigation to establish the facts about existing services, and, second, a more comprehensive survey, potentially to be used as the basis of recommendations for post-​war reconstruction. Titmuss and Lafitte were given the task of preparing a draft statement.46 A few months later it was agreed that the pre-​war ‘Programme of Future Research’

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should be updated and include references to housing, maternity provision, and child welfare.Titmuss, along with Glass and Kuczynski, was charged with this redrafting, although most of the work seems to have been done by Glass.47 These three were also initially asked to prepare a memorandum on the ‘Reform of Vital Statistics’, to be submitted to the Royal Commission on Population, although this was not in fact used as Carr-​Saunders, Glass, and Kuczynski were to be members of the Royal Commission’s Statistics Committee.48 Nonetheless, his early involvement does remind us of Titmuss’s lifelong concern over the quality of official data. His employment as a civil servant, on the other hand, no doubt curtailed any more public activities on the PIC’s behalf. One notable PIC initiative was the formation of a committee, jointly with the Royal College of Obstetricians and Gynaecologists, to survey maternity services. The enquiry was funded by grants from the National Birthday Trust Fund, set up in 1928 to tackle problems of maternal mortality, and the Nuffield Foundation. As the subtitle of the published report makes clear, the focus was very much to be on the ‘Social and Economic Aspects of Pregnancy and Childbirth’.49 This was a sign of the times, reflecting the analyses of commentators such as Titmuss, and contemporary developments in social medicine. The investigation was chaired by Professor James Young, a leading figure in obstetrics and gynaecology, and included Titmuss, Blacker, Glass, and Lady Rhys Williams.50 Rhys Williams had been a founder member of the National Birthday Trust Fund, was a prominent member of the Economic Research Council, a leading advocate of improvements in maternity services, and, in the early part of the Second World War, had published on issues close to Titmuss’s heart, notably family allowances. She was active in the Liberal Party, as was Titmuss until the early 1940s. Oakley points out that the two had corresponded prior to the war on issues around infant mortality, and that Rhys Williams had been impressed by Titmuss’s work.51 Titmuss did a considerable amount of reading, and statistical commentary, on various drafts of the report, eventually published in 1948. For example, in autumn 1947 he acknowledged the receipt of five draft chapters, and asked of his correspondent that he be allowed to retain copies as these would be ‘extremely useful to me as a member of the Midwifery Working Party’.52 This was a reference to the Working Party set up by the Ministry of Health and the Scottish Office to look into the recruitment and training of midwives. Titmuss had been engaged as a representative of the Cabinet Office, and the Working Party, which was chaired by Mary Stocks (later a prominent figure on BBC radio, and a biographer of Eleanor Rathbone), also included Dr Albertine

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Winner from the Ministry of Health, someone with whom Titmuss enjoyed a long and friendly relationship, and presumably known to him already.53 The more general point is that Titmuss was, by this point, clearly identified as an authority on issues around childbirth, and it is notable that, in his application to the LSE, he drew attention to his Working Party membership.

Conclusion Titmuss played an active part in the Eugenics Society, and its offshoot the PIC, throughout the war. As before 1939, he was determined to promote a version of eugenics which prioritised nurture over nature, and to address issues of population health. His commitment to the Society was reciprocated by its support for Birth, Poverty and Wealth, a work which focused especially on infant mortality. While not saying anything which Titmuss had not said before, it nonetheless consolidated his views, and should be seen more broadly as a further contribution to ‘progressive opinion’, and proposals for post-​war reconstruction. Importantly, at least for Titmuss, it was well received.The next chapter examines further aspects of his media profile. Notes 1 ‘Annual Report, 1939–​40’, Eugenics Review, 32, 1, 1940, p 32. 2 EUGENICS, SA/​EUG/​C.33, letter, 18 September 1939, RMT to Ursula Grant-​Duff. 3 ‘Notes of the Quarter’, Eugenics Review, 32, 2, 1940, pp 47–​8. 4 ‘Eugenics Society: Annual Meeting and Election of Officers and Council’, Eugenics Review, 37, 2, 1945, p 73. 5 ‘Annual Report, 1941–​2’, Eugenics Review, 34, 1, 1942, p 40. 6 ‘Notes of the Quarter’, Eugenics Review, 33, 4, 1942, pp 99–​105. 7 ‘Notes of the Quarter’, Eugenics Review, 34, 1, 1942, pp 3–​9. 8 R.M.Titmuss and F. Lafitte, ‘Eugenics and Poverty’, Eugenics Review, 33, 4, 1942, pp 106–​12 (emphasis in the original). 9 ‘Eugenic Aspects of Social Security’, Eugenics Review, 36, 1, 1944, pp 17–​24. 10 L. Bland and L. Hall, ‘Eugenics in Britain: The View from the Metropole’, in A. Bashford and P. Levine (eds), The Oxford Handbook of the History of Eugenics, Oxford, Oxford University Press, 2010, p 218. 11 C. Lawrence and G. Weisz, ‘Medical Holism: The Context’, in C. Lawrence and G. Weisz (eds), Greater than the Parts: Holism in Biomedicine, 1920–​1950, New York, Oxford University Press, 1998, p 7. 12 R.M. Titmuss, ‘The Effect of the War on the Birth Rate’, Eugenics Review, 34, 1, 1942, p 12. 13 R.M.Titmuss,‘The Significance of Recent Birth-​Rate Figures’, Eugenics Review, 35, 2, 1943, pp 36–​8.

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Titmuss and the Eugenics Society in war 14 R.M. Titmuss, ‘Infant and Maternal Mortality’, Eugenics Review, 34, 3, 1942, pp  85–​90. 15 EUGENICS, SA/​EUG/​C.333, letter, 20 October 1943, Blacker to RMT. 16 EUGENICS, SA/​EUG/​C.333, flyer, ‘The Eugenics Society, Members’ Meeting Tuesday November 16th 1943’ and ‘For the Press:  Abstract of Paper’, 11 November 1943. 17 R.A. Soloway, Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth Century Britain, Chapel Hill, University of North Carolina Press, 1990, pp 18ff. 18 R.M. Titmuss, ‘The Social Environment and Eugenics’, Eugenics Review, 36, 2, 1944, pp 56, 57. 19 EUGENICS, SA/​EUG/​C.333, letter, 30 June 1942, Blacker to Bramwell; and letter, 30 June 1942, Blacker to Newfield. 20 Soloway, Demography and Degeneration, p 201. 21 Titmuss, Birth, Poverty and Wealth, p 5. 22 Ibid, pp 9–​10. 23 EUGENICS, SA/​EUG/​C.333, letter, 20 October 1943, Blacker to RMT. 24 Titmuss, Birth, Poverty and Wealth, pp 11, 59–​60, 62, 88, 90 (emphasis in the original), 99, 100–​101. 25 R.R. Kuczynski, ‘Infant Mortality’, Eugenics Review, 35, 3–​4, 1943, pp 86–​7. 26 Medical Correspondent, ‘The Infant Mortality Rate’, The Times, 29 September 1943, p 5. 27 TITMUSS/​7/​51, letter, 1 December 1943, E.P.Whelan, Branch Secretary, Central London Branch of the Association of Scientific Workers, to RMT. 28 TITMUSS/​8/​5, letter, 15 October 1943, Acland to RMT. 29 R. Bud, ‘Lancelot Thomas Hogben’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 30 PIC, SA/​PIC/​A/​1/​1, the document by C.P. Blacker, ‘Investigation of Medical Causes of Infertility’, nd, but presumably 1937/​38 lists, at p 1, PIC members. 31 L. Hogben, ‘Infant Mortality’, Nature, 152, 3860, 23 October 1943, pp 460–​61. Karl Pearson was an important statistician and central to the propagation of Galton’s views. 32 ‘Notes of the Quarter’, Eugenics Review, 35, 3/​4, 1943, pp 54–​5. 33 TITMUSS/​7/​51, letter, 1 May 1943, RMT to Dr Kuczynski. 34 Report of the Royal Commission on Population, Cmd.7695, London, HMSO, 1949. 35 P. Thane, Divided Kingdom: A History of Britain, 1900 to the Present, Cambridge, Cambridge University Press, 2018, p 209. 36 TITMUSS/​4/​546, Minutes of a Meeting of the General Purposes Committee, PIC, 12 June 1946 where it was agreed to set up the journal, and noted that the LSE would provide accommodation for PIC personnel. 37 E. Grebenik,‘Demographic Research in Britain, 1936–​1986’, Population Studies, 45, S1, 1991, pp 3–​30; and C. Renwick, ‘Eugenics, Population Research, and Social Mobility Studies in Early and Mid-​Twentieth Century Britain’, The Historical Journal, 59, 3, 2016, pp 845–​67. 38 PIC, SA/​PIC/​A/​1/​1, A.M. Carr-​Saunders, ‘Memorandum on the Work of the Population Investigation Committee’, undated but 1937/​38, p 1. 39 Renwick, ‘Eugenics’, p 855ff. 40 PIC, SA/​PIC/​A/​1/​1, C.P. Blacker,‘Investigation of Medical Causes of Infertility’, undated but 1937/​38, p 1; and SA/​PIC/​A/​1/​2/​2, ‘Application to the Nuffield Foundation, 9 April 1945’, p 1 and attachment.

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RICHARD TITMUSS 41 ‘Annual Report 1939–​40’, Eugenics Review, 32, 1, 1940, p 32; and ‘Notes of the Quarter’, Eugenics Review, 35, 1, 1943, pp 4–​7. 42 R.M. Titmuss, Eugenics Review, 32, 2, 1940, pp 61–​2. 43 PIC, SA/​PIC/​A/​1/​1, ‘Minutes of a Meeting of the General Purposes Sub-​ Committee of the Population Investigation Committee, 16 February 1943, p 2; and Memorandum, ‘Summary of Researches Proposed’, undated but 1942 (?). 44 PIC, SA/​PIC/​A/​1/​1, ‘Minutes of a Meeting of the General Purposes Sub-​ Committee of the Population Investigation Committee, 16 February 1943, p 2. 45 TITMUSS/​4/​543, Minutes of a Meeting of the General Purposes Sub-​ Committee, 1 July 1943, p 2. 46 PIC, SA/​PIC/​A/​1/​2/​2, Minutes of a Meeting of the Sub-​Committee on Maternity and Child Welfare, 26 July 1943, p 1. 47 PIC, SA/​PIC/​A/​1/​2/​1, Minutes of a Meeting of the General Purposes Sub-​ Committee of the Population Investigation Committee, 24 September 1943. 48 PIC, SA/​PIC/​A/​1/​2/​1, Minutes of a Meeting of the General Purposes Sub-​ Committee of the Population Investigation Committee, 5 May 1944; and Minutes of a Meeting of the Population Investigation Committee, 4 December 1944. 49 Maternity in Great Britain: A Survey of Social and Economic Aspects of Pregnancy and Childbirth Undertaken by a Joint Committee of the Royal College of Obstetricians and Gynaecologists and the Population Investigation Committee, London, Oxford University Press, 1948, p v. 50 TITMUSS/​4/​544, ‘Minutes of a Meeting of the Joint Committee of the Royal College of Obstetricians and Gynaecologists and the Population Investigation Committee Regarding and Inquiry into the Maternity Services, 27th June 1945’. 51 W. Nicoll, ‘Dame Juliet Evangeline Rhys Williams’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004; Oakley, Man and Wife, p 111. 52 TITMUSS/​4/​544, letter, 29 October 1947, RMT to Dr J.W.B. Douglas, Director of the survey. 53 ‘Shortage of Midwives’, The Times, 21 April 1947, p 8.

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8 Titmuss and the media in the 1940s: a growing reputation Introduction We saw in Chapter 3 that, in the 1930s,Titmuss had employed a literary agent.This relationship does not appear to have survived the outbreak of war, with Titmuss now often contacting editors and journals directly. And such was Titmuss’s growing reputation, at least in the first half of the 1940s primarily regarding population, that he began to be approached by publishers themselves, as well as by various organisations. He was also politically active down to the early 1940s, and although his employment as a civil servant curtailed his public activities, he continued to be in demand, especially as plans for post-​war social reconstruction gathered momentum. This reinforces the previously noted idea of Titmuss seeking to spread his ideas to as wide and diverse an audience as possible, so promoting his ‘progressive’ views. The 1940s were important, too, in providing the further platform of radio broadcasts. As always, it is difficult not to be impressed by Titmuss’s work-​rate. Such outputs, and again this was to feature throughout his career, often provided a handsome financial supplement to his salary. It would be impossible, and not especially enlightening, to list all of Titmuss’s contributions to various media during the period under consideration. So here we look at some of his more significant, or interesting, interventions.The aim is less to discuss their content in detail. Rather, it is to give a sense of the range of Titmuss’s engagement.

Writing and lecturing Illustrating a number of these points, in November 1943 the publisher Victor Gollancz, founder of the Left Book Club which operated as a

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‘sort of reading “Popular Front” ’, asked Titmuss for a contribution on population and poverty to the journal Left News. Titmuss agreed, on condition that the piece be unsigned, given that he was now a civil servant. He was paid two guineas per 1,000 words for ‘The Casualties of Inequality’, in which he referred to himself in the third person, and cited Birth, Poverty and Wealth.1 A guinea was, in pre-​decimalisation currency, one pound and one shilling, while the average wage at this time was between six and seven pounds per week. Titmuss’s fee was, therefore, not insubstantial. As this episode also illustrates, it is clear that Titmuss’s ideas were valued by those on the political left, perhaps reinforcing the idea of a shift away from the Liberal Party, although not necessarily liberalism. In late 1942, he was invited by Elizabeth Bunbury, a leading member of the Socialist Medical Association (SMA), the group of left-​wing doctors affiliated to the Labour Party to which his friend Jerry Morris was close, to lecture on ‘public health’ to medical students. By this point, Titmuss and Morris were beginning to contribute to the advance of social medicine, a discipline which sought to develop new approaches to preventive medicine. Titmuss felt obliged to turn this request down since his attachment to the Cabinet Office made it ‘very difficult for me to address an open meeting on the subject of public health’.2 Although nothing came of this particular invitation, at least immediately, what is notable here was that Titmuss was asked in the first place, and the implication that he might be prepared to talk to closed meetings. In the future, he was to work closely with the SMA on issues such as social work and health. Titmuss’s assumed expertise in public health is likewise noteworthy. In 1943, meanwhile, the Association for Education in Citizenship, which Eva Hubback had co-​founded in 1934, published his Problems of Population in the series ‘Handbooks for Discussion Groups’.The series was designed, by way of both descriptive material and the questions posed by the author, to stimulate debate in groups assembled to engage with what the Association saw as significant contemporary issues. The generic title of the series was ‘Unless We Plan Now’, and other contributors included Morris on health. As the organisation’s name suggests, it was yet another of those bodies promoting ‘progressive’, or ‘middle’, opinion in the 1930s in the face of widespread socioeconomic disruption and international tension. By the 1940s, though, the focus was firmly on post-​war reconstruction. Titmuss’s contribution to the series was very similar in content and presentation to a second pamphlet discussed immediately below, so just a couple of points from the first publication are worth highlighting. Titmuss started off by claiming that people often asked why so much

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fuss was made about population, remarking further that it did not really concern them. But that was ‘precisely where they are wrong’. He then went on to explain why this was so, before moving on more specifically, and in now familiar terms, to the issue of parenthood. In Western societies,‘parents have deliberately decided to limit their families through continence, by employing birth control and by marrying late in life’.This, and associated trends, had some ‘unpleasant consequences’, potentially including increased unemployment. Family allowances would, under the right circumstances, help, but other issues also had to be addressed. What was the impact, for example, of the ‘social and economic atmosphere’ on possible parenthood? In the last resort, then, this was a problem for ‘parents both actual and potential’, and was thus ‘one for the people to decide’. It was ‘they who give the community its future citizens, it is for them to decide what form of society –​whether their own or some form not yet in existence –​will encourage and not deter parenthood’.3 His qualifications notwithstanding, Titmuss’s support for family allowances should be seen in the broader context of such measures rising up the domestic political agenda, as social reconstruction became the order of the day. Family allowances continued to be promoted by his friend Eleanor Rathbone, their implementation was one of the ‘Assumptions’ of the Beveridge Report, and the Labour Party and the previously reluctant Trades Union Congress were increasingly supportive.4 Also in 1943 came an important opportunity to influence a much larger, and captive, audience when Titmuss was approached by Major R.L. Wakeford of the Army Bureau of Current Affairs (ABCA). This body had been set up in 1941 to provide compulsory educational instruction about contemporary issues for rank and file soldiers. Central to its programme was the series Current Affairs, which aimed ‘to provide a background of knowledge against which events can be assessed and understood’. Publications in the series, written by experts commissioned by ABCA, were thus designed to stimulate discussion groups consisting of troops, and led by officers. By the time of Titmuss’s contribution, the series was very much geared to post-​war reconstruction, something which the army’s internal enquiries had revealed as of considerable interest to its personnel. The educational benefits were also seen to extend even wider given that, as one senior general put it, ‘millions of men and women [in the army] were ill-​educated’, and there was thus an obligation to return them to civilian life educationally better equipped.5 The troops’ interest in post-​war reconstruction, and the centrality of education, matched the mood on the Home Front, especially since

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the 1942 publication of the Beveridge Report. One early indicator of the creation of what was to become the ‘welfare state’ was the passage of the 1944 Education Act. This had achieved all-​party support, significantly expanded educational provision and associated welfare measures such as school meals, and was a piece of legislation to which Titmuss’s inspiration, Tawney, had made a notable contribution.6 Eva Hubback’s daughter, meanwhile, suggests that the army’s approach to what was effectively another form of education for citizenship was strongly influenced by the ‘Handbooks for Discussion’ series.7 The bureau was to be blamed, retrospectively, by the Conservative Party for ‘radicalising’ the army, so contributing to Labour’s landslide win at the 1945 general election.8 Wakeford explained to Titmuss that what he wanted was a pamphlet on the ‘population problem’ which officers could use in their group discussions.9 The result was Fewer Children:  The Population Problem, which came out in December 1944, that is a few months after the Normandy landings, and hence as the Second World War was entering its final phase. Unsurprisingly, this publication revisited a number of concerns about which Titmuss had been exercised for some time, and would continue to be so for some time to come. The editorial introduction, aimed at the officers charged with leading discussion and melodramatically entitled ‘The Birth of a Nation:  A Problem that Governs All Others’, noted that Titmuss’s contribution was about a subject which was ‘fundamental. It is about our population’. Essentially, the British population was ‘not replacing itself and is, therefore, heading towards extinction’, and so ‘Titmuss shows in his article how certain changes are already inevitably due within the lifetime of most of us in the Army today’. This was, then, ‘a cause for alarm but not despondency’. The anonymous author had clearly taken Titmuss’s message to heart.Various suggestions were given as to how a discussion might be structured, for example by asking the troops how many children their parents and their grandparents respectively had had. This could then be backed up by use of the illustrations contained in the pamphlet, and transferred to a blackboard.10 Titmuss himself drew extensively, as might be expected, on his own demographic research and, especially, Parents Revolt, discussed in the next chapter. For instance, he suggested that the population of England and Wales would fall from just under 41 million in 1940 to just over 37 million by 1970, then further still, to just under 20 million, by 2000. Crucially, the proportion of the population under 30 years of age would steadily decrease.All this would be brought about by an ongoing decline in the birth rate. What lay behind this? The pamphlet was, as noted,

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overtly educational, and designed to stimulate discussion. So Titmuss posed a series of provocative questions. Was ‘mass selfishness the cause of the falling birth rate?’ Did the ‘the majority of married couples only want to have a “good time” ’? Had the ‘desire for children, the wish to carry on the family, the demand for a happy family life diminished among modern parents?’ If ‘selfishness’ was not the cause, what was? ‘These’,Titmuss suggested, were ‘points for you to discuss’.11 The way these questions were posed might be seen as channelling discussion in the sort of directions Titmuss himself wanted. We have seen from previous chapters, and will see on many other occasions, that Titmuss was very much of the view that ‘selfishness’, a key component of the ‘acquisitive society’, was at the heart of the matter, in turn a product of the psychological strains induced by contemporary capitalism. His predictions on future population size were, as previously, wildly out. Nonetheless, taken together these two pamphlets do, once again, illustrate what Titmuss saw as the centrality of the population question, and his belief that this was something with which society had to deal urgently. Family allowances, shortly to be introduced by the outgoing wartime government, were necessary, but not sufficient, to address the problem. More fundamental was the unwillingness of parents to have children, so resulting in ‘unpleasant consequences’, such as the falling birth rate and an ageing population. Ultimately, the underlying issue was selfishness and acquisitiveness –​married couples having a ‘good time’ at the expense of starting or expanding their families. Such challenging arguments were consciously constructed to stimulate discussion and debate.Titmuss knew as well as anyone that for many people, married or otherwise, a ‘good time’ had not been their experience in the crisis-​ ridden 1930s, or during total war in the 1940s. However, his own diagnosis, and prognosis, were clear enough. More broadly, the invitations to contribute to both these series of publications, but especially that of the ABCA, are yet further indicators of his burgeoning reputation. If Titmuss was active in the printed media, the 1940s also afforded him the opportunity to hone further his public-​speaking skills, already well developed by the outbreak of war through participation in bodies such as the Fleet Street Parliament, by addressing a wide variety of audiences. Many of those interviewed for this book spoke of Titmuss’s engaging style when leading discussions or lecturing, and this aspect of his personality, as well as his acknowledged research skills, appears to have led to a number of invitations as a speaker. To show the diversity of his audiences, we take three examples from the mid-​1940s. In May 1946 the director of the Royal Navy Current Affairs course wrote thanking him ‘for coming down to speak to us last week and giving

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us such an instructive talk on Population Problems’. A cheque for two guineas was attached.12 The text of this talk does not seem to have survived, but there is no reason to assume that Titmuss deviated from his previous stance on this issue. The navy had resisted compulsory discussion groups as held in the army, but in the immediate post-​war years put on a number of classes in current affairs and citizenship, and it was presumably to one of these that Titmuss had contributed.13 Among other speakers employed to such ends by the navy was someone Titmuss was going to have a lot to do with in later years, the future Labour leader and Prime Minister, Harold Wilson. It is likely, in fact, that by this point they already knew each other given that both worked in wartime Whitehall, Wilson famously for Beveridge.14 Moving away from talks entirely focused on population issues, Titmuss was on the Historical Association’s list of speakers by the mid-​1940s. The Association had been set up in the early twentieth century to support history teaching in schools, and in 1947 Titmuss was thanked for his ‘co-​operation in the past’, and asked to confirm the topics on which he was prepared to speak. In addition to population, he proposed the history of the health and social services from the beginning of the nineteenth century.15 As we saw in Chapter 6, this was a topic in which Titmuss had a strong interest, and further evidence of his historical approach. In the same year, he agreed to speak to the Six Point Group on the subject of ‘Family Equality’. The Group was a small, but high-​powered and influential, feminist body seeking full equality in the political, occupational, moral, social, economic, and legal spheres –​the six points. It had an important platform in the journal Time and Tide. By the mid-​1940s it was led by a number of impressive individuals, including leading SMA activist and Labour MP Edith Summerskill. During the war the organisation had been in touch with the Ministry of Health over issues around evacuation, so it is highly likely that Titmuss knew, or knew of, some of its key players.16 The Six Point Group, like many at the time, was certainly concerned with what Time and Tide described, in early 1946, as ‘The Problem of the Family’. The solution to this was complicated, but would require ‘positive measures’ to arrest the decline in family size, and these would have ‘fundamental effects on educational, housing, health and taxation policy’.17 Although, once again,Titmuss’s address does not seem to have survived, such views closely accorded with his own, almost certainly the reason for his invitation. More generally, that Titmuss should receive invitations from such different organisations is, once again, indicative of his growing reputation, and can only have boosted his sense of self. That Titmuss spoke to the Six Point Group was especially noteworthy

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for, as we shall see, some of his most important lectures in the 1950s were to address, in the title of one of them, ‘The Position of Women’. This, in turn, raises important questions about Titmuss’s more general approach to gender equality, and how this informed, for example, his dispute with LSE social workers in the mid-​1950s.

On the air Titmuss maintained his pre-​war strategy of placing articles in a wide range of publications, and of using talks and addresses as platforms to publicise, and test, his views.This mix of activities was to continue for the rest of his life. But what is especially interesting in the 1940s was Titmuss’s burgeoning work for the broadcast media.Titmuss’s engagement with the BBC, at this time a monopoly provider of such media, was something he shared with his future close friend and colleague, Richard Crossman, who worked for the Corporation’s German Service.18 From around 1941, Richard Weight suggests, there was an increase in BBC output dealing with social issues, especially those to do with social reconstruction.These broadcasts were made by ‘planning experts, doctors, educationalists and church leaders’ who, in turn, were to be the ‘technocrats, philanthropists and bureaucrats’ populating the ‘policy-​making committees of the Welfare State and the Planned Economy’. Here they would work alongside voluntary and professional bodies, with the ultimate task of offering policy advice.19 Titmuss thus needs to be seen in this broader framework, while bearing in mind also the moral, rather than simply technocratic, underpinnings of his work. In early summer 1942,Titmuss was contacted by the novelist, essayist, and polemicist George Orwell, who between 1941 and 1943 was talks producer at the BBC’s Empire Service India Section. Orwell asked Titmuss if he would consider ‘doing a talk for us in the series which we shall be broadcasting to India during June and July’. The series, called ‘AD 2000’, would deal with India’s future, ‘the idea being that it is an attempt to forecast what is likely to be happening fifty or sixty years hence’. Orwell was looking for someone to discuss India’s population ‘problem’, and Titmuss was ‘much the most suitable person to do it, and you could approach it from whatever angle you liked’. It is not clear whether Titmuss and Orwell knew each other personally, but they certainly had friends and acquaintances in common, for instance the publisher Victor Gollancz.20 The way Orwell formulated his request also implies knowledge of Titmuss’s ideas. Titmuss clearly agreed to Orwell’s suggestion, for around two weeks later Orwell got back to him with thanks for the script he had been sent. It was ‘just

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the kind of thing I wanted’.21 Titmuss was duly commissioned, for a fee of ten guineas, to talk for 20 minutes on the ‘Indian Population Problem’ on a programme to be transmitted on 3 July by the Indian Empire Service.22 The context here is the accelerating, and ultimately successful, demand within India for self-​government. More specifically, Titmuss’s talk came just a few months after the catastrophic loss to the British Empire of the base at Singapore which further advanced the nationalist cause across Asia, while posing a military threat to India itself. This was perhaps the lowest point in what John Darwin describes as the ‘Strategic Abyss’ which Britain had been facing since the late 1930s.23 The potential for a rapid expansion of India’s population, in contrast to the situation in Britain, was a topic to which Titmuss returned on a number of occasions. A few months later, Titmuss appeared on the BBC Home Service. He had been asked to participate, the fee this time being seven guineas, in a discussion programme entitled ‘Too Few Babies’, to be broadcast in mid-​November 1942.24 As the title suggests, the basic premise here was that the British population would face serious decline unless the birth rate improved. In the course of the discussion,Titmuss responded to another participant, a Mrs Norris, who had argued that any such rise could help make ‘the world spiritually whole again’ (she did not specify how this might happen). Titmuss suggested, possibly tongue in cheek, that this raised ‘a new point, which is probably too big to deal with tonight’. But there was general agreement that ‘we cannot hope to induce people to have more children until economic insecurity and the fear of war have been eliminated. We’ve got to have more economic planning to achieve security’. He then addressed the spirituality question more directly, arguing that ‘in another sense we’ve also got to return to higher social values –​call them spiritual if you like –​less snobbery, less “keeping up with the Jones’s” in every field’.25 Titmuss did not spell out here his critique of the ‘acquisitive society’, but it is clearly implicit in what he said, not least in the (now virtually unused) expression, ‘keeping up with the Jones’s’. Likewise his call for ‘economic planning’ returned to a well-​established concern about the consequences of unbridled capitalism, as did the need for ‘higher social values’.This particular programme seems to have evoked quite a reaction. A BBC employee sent Titmuss some letters the Corporation had received, and in response he claimed that he had had ‘many reactions to the broadcast and everyone [sic] of them has been exceptionally favourable’. ‘A number of people whose judgement I  respect’, he continued, ‘were all impressed by the content of the discussion and,

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curiously enough, the delivery –​not excepting my own.’Turning on the charm, he told his correspondent –​presumably either the interviewer or the producer –​that he attributed this ‘to the careful grooming you gave us all and I think you are to be congratulated on handling such a thorny topic’.26 The following year, Titmuss was again contacted by the BBC, this time by its European Talks Editor, who had been given his name by the Royal Statistical Society. The topic the editor was looking into was the birth rate in the Allied powers (he used the expression ‘United Nations’, coined by President Roosevelt in 1942), as compared to that of the Axis powers. ‘In particular’, he continued, ‘of course, we would like to bring out that Hitler is destroying Germany’s future by once again sacrificing German manpower’.27 As we have seen, this was a topic Titmuss had addressed on a number of occasions, and presumably explains his recommendation by the Royal Statistical Society.The subject,Titmuss responded, was not an easy one to handle in a ‘popular manner’, but he did submit a script which argued that the German armed forces were facing an acute manpower shortage, while suffering huge casualties on the Eastern Front.The population aged between 16 and 24 years was now in decline, and so the ‘seeds sown by the Kaiser and his war lords in 1914’ had at last begun ‘to bear fruit. But this time it is barren fruit’.28 It is not clear if this piece was actually broadcast, although Titmuss did receive four guineas, and was commissioned to do a talk at some future date on the German birth rate.29 The subject was certainly timely, given Germany’s heavy defeat earlier in 1943 at Stalingrad, and the Red Army’s subsequent remorseless advances. Titmuss also had the opportunity to speak directly on the radio to the armed forces, just as he had in print through his ABCA pamphlet. In December 1944, just a few weeks after the pamphlet was published, he appeared on the programme ‘Your Questions Answered’. Titmuss, as his interviewer put it an ‘expert on population problems’, was there to answer questions specifically on migration. The programme began with a discussion on which countries ‘need people’, with a particular focus on the so-​called ‘White Dominions’ of the Commonwealth, that is, Canada, Australia, New Zealand, and South Africa. The conversation then turned to ‘overpopulated’ areas, such as India and Japan. As we have seen, Titmuss took an interest in Asian population trends. Summing up, the interviewer suggested that a ‘great revival of overseas settlement after the war is rather unlikely’. Titmuss agreed. Although a certain amount of movement would take place, ‘neither we, nor the Dominions, nor any other country can solve our problems of too many

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or too few people, too much or too little food, by the mass shifting about of millions of people’.30 Ironically, the involuntary displacement of millions of people would occur once the war came to an end. And it was not only India, Britain, and the armed forces which had the benefit of hearing Titmuss on air. In March 1945 the BBC Pacific Service broadcast his talk ‘Calling the Islands: The Health Survey’. This was notable not least because of the work Titmuss was now doing with Jerry Morris. Titmuss told his audience that the ‘social and medical survey is quite a new instrument’, and it was only in ‘recent years that we’ve begun to use it as a guide to official policy’. The data acquired was essential, for without it would be ‘impossible for authorities to introduce medical advance, to reduce ill-​health and disease and improve living standards, because we must have knowledge as a first step’. Large-​scale health surveys were especially valuable when addressing preventable diseases, such as tuberculosis, and information was collected about the personal and social circumstances of those affected, for example their occupations and diet. Like many other commentators on health at this time, Titmuss invoked a military metaphor in the struggle against disease: ‘The first task, you see, is to identify the enemy, his range and strength –​that is the job of the survey –​and then, when we know where the enemy flourished, he can be attacked.’31 Back broadcasting to Britain, and now post-​war, Titmuss told listeners to the popular BBC radio programme ‘Woman’s Hour’ that if he believed everything he read in the newspapers, ‘I should say that most housewives violently object to being asked questions by people interested in social problems. But I should be wrong –​hopelessly wrong. And I’ll tell you why.’ His talk, entitled ‘Report on Childbearing’, then went on to describe an investigation into childbirth being carried out on behalf of the Population Investigation Committee.32 This was the survey encountered in the last chapter, carried out jointly with the Royal College of Obstetricians and Gynaecologists, and the fact that it was picked up by a popular radio programme shows the interest its subject matter engendered. Nor were Titmuss’s broadcasting activities confined to the radio. Although it is not clear whether he actually appeared in it, nonetheless in 1946 he received a cheque for £21 from a production company in respect of a film called ‘Declining Birthrate’. A handwritten note on the relevant letter, ‘he advised them on it’, is presumably by Kay, and the opening line of the draft script proclaims a by now familiar view: ‘Britain, for the first time in her history, is faced with the prospect of a declining population.’33

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Conclusion From the outset, Titmuss was determined to make his views known to as broad an audience as possible. This chapter has shown how this extended, and expanded, into the 1940s, and through a variety of media. He addressed audiences ranging from armed services personnel to middle class feminists, both directly and in writing. There is a further dimension to this. Titmuss is often portrayed as a rather reserved, modest, individual. On a personal level, this may have been true. But he was not so reserved, or modest, as to decline the opportunity to appear extensively on broadcast media, a daunting prospect on any occasion, perhaps especially so in wartime. That he was asked to do so was assuredly a sign of his standing as a social commentator. From the 1940s, then, Titmuss was a ‘public intellectual’ before that phrase was concocted. Appearances on radio, and later television, were to be an important part of his subsequent career, until a few weeks before his death. Notes 1 D. Todman, Britain’s War:  Into Battle, 1937–​1941, London, Allen Lane, 2016, p 107; TITMUSS/​7/​51, letter, and attached typescript, 7 November 1943, RMT to Gollancz. 2 TITMUSS/​7/​50, letter, 16 November 1942, Bunbury to RMT; and letter, 23 November 1942, RMT to Bunbury. 3 R.M. Titmuss, Problems of Population:  Handbooks for Discussion Groups, No 9, London, Association for Education in Citizenship, 1943 (?), pp 1, 16, 18, 20, 21 (emphasis in the original). 4 S. Pedersen, Family, Dependence, and the Origins of the Welfare State:  Britain and France, 1914–​1945, Cambridge, Cambridge University Press, 1993, Ch 6. 5 S.P. MacKenzie, Politics and Military Morale: Current Affairs and Citizenship Education in the British Army, 1914–​1950, Oxford, Oxford University Press, 1992, p 94 citing an Army Council directive, 130, and 158 citing General Sir Archibald Nye. 6 H-​Y. Ku, ‘Fighting for Social Democracy:  R.H. Tawney and Educational Reconstruction in the Second World War’, Paedagogica Historica, 52, 3, 2016, pp 266–​85. 7 D. Hopkinson, Family Inheritance: A Life of Eva Hubback, London, Staple Press, 1954, p 153. 8 A. Calder, The People’s War: Britain 1939–​1945, London, Pimlico, 1992 [1969], pp  251–​2. 9 TITMUSS/​7/​51, letter, 1 May 1943,Wakeford to RMT; and letter, 8 June 1943, RMT to Wakeford suggesting a meeting, which presumably took place. 10 R.M.Titmuss,‘Fewer Children: The Population Problem’, Current Affairs, No 83, Army Bureau of Current Affairs, 2 December 1944, editorial introduction ‘The Birth of a Nation’, pp 2–​3. 11 Ibid., pp 9, 11, 5, 14.

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RICHARD TITMUSS 12 TITMUSS/​7/​54, letter, 7 May 1946, Commander S.W. Pack to RMT. 13 MacKenzie, Politics and Military Morale, pp 225–​8. 14 B. Pimlott, Harold Wilson, London, HarperCollins, 2016 (1992), p 88. 15 TITMUSS/​7/​55, letter, 26 March 1947, J.W. Herbert,The Historical Association, to RMT, with notes by latter. 16 TITMUSS/​7/​55, letter, 8 January 1947, RMT to Miss L. Evans, member of the Executive Committee of the Six Point Group; M. Pugh, Women and the Women’s Movement in Britain, 1914–​1999, London, Macmillan, 2nd edn 2000, pp 301, 276. 17 ‘The Problem of the Family’, Time and Tide, 9 February 1946, p 124. 18 See the references in E. Stourton, Auntie’s War: The BBC during the Second World War, London, Doubleday, 2017. 19 R.Weight,‘State, Intelligentsia and the Promotion of National Culture in Britain, 1939–​45’, Historical Research, 69, 168, 1996, p 93. 20 TITMUSS/​7/​50, letter, 19 May 1942, Orwell to RMT; R.  Colls, George Orwell: English Rebel, Oxford, Oxford University Press, 2013, pp 145–​6. 21 TITMUSS/​7/​50, postcard, 4 June 1942, Eric Blair (George Orwell) to RMT. 22 TITMUSS/​7/​50, letter, 10 June 1942, BBC to RMT. 23 J. Darwin, The Empire Project: The Rise and Fall of the British World System, 1830–​ 1970, Cambridge, Cambridge University Press, 2009, Ch 11. 24 TITMUSS/​7/​50, letter, 31 October 1942, BBC to RMT. 25 TITMUSS/​7/​50, typescript, ‘Too Few Babies’, p 7. 26 TITMUSS/​7/​50, letter, 23 November 1942, RMT to John Pringle. 27 TITMUSS/​7/​50, letter, 7 October 1943, M. Zvegintzov to RMT. 28 TITMUSS/​7/​50, letter, 15 October 1943, RMT to Zvegintzov, and two-​page typescript ‘Men and Babies’. 29 TITMUSS/​7/​50, letter, 10 November 1942, Zvegintzov to RMT. 30 TITMUSS/​4/​556, four-​page typescript,‘Your Questions Answered’, for broadcast on General Forces Programme, 21 and 23 December 1944. 31 TITMUSS/​7/​52, three-​page typescript, R.M.Titmuss, ‘Calling the Islands: The Health Survey’, broadcast by BBC Pacific Service, 27 March 1945. 32 TITMUSS/​7/​55, three-​page typescript, R.M.Titmuss,‘Report on Childbearing’, to be broadcast on ‘Woman’s Hour’, 11 July 1947. 33 TITMUSS/​7/​54, letter, 5 June 1946, Deputy Accountant, Production Facilities (Films) Ltd to RMT and typescript ‘Declining Birthrate’, p 1.

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9 Population and family: Parents Revolt and the beginnings of social medicine Introduction This chapter starts with a discussion of Titmuss’s only publication jointly authored with Kay, Parents Revolt, published in 1942. Titmuss later claimed that it had been ‘partly written in an air raid shelter in Pimlico’, the area of London where he and Kay lived.1 This work once again engages with Titmuss’s major preoccupations of the 1930s and 1940s, his concerns about population, population health, and the moral implications of materialism, and was clearly intended to reach a wider audience than simply those interested in eugenics or demography. In this respect, Parents Revolt links more closely with the material discussed in Chapters 5 and 8. Further examples of Titmuss’s interventions in these fields are then briefly discussed, before turning to the logical outcome of his interests in population health.This was the engagement by Titmuss, and Jerry Morris, with the emerging discipline of social medicine, and the subsequent creation of the Social Medicine Research Unit. It is shown that Titmuss and Morris were among the pioneers of social medicine in Britain, especially through the publication of what were to become foundational articles for the field.

Parents Revolt The subtitle of Titmuss and Kay’s volume, A Study in the Declining Birth-​ Rate in Acquisitive Societies, was revealing for, as we have seen, Titmuss was much taken with Tawney’s notion of the ‘acquisitive society’. The book included a preface by the veteran Fabian socialist Beatrice Webb,

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who claimed that it raised,‘in a series of brilliantly graphic chapters’, the ‘crucial question of the fall of the birth-​rate, threatening the survival of the white race’. Rather than producing an academic work of demography the authors had, in a reference to wartime rationing, ‘preferred to use the short supply of paper to prove the fall in the birth-​rate as a public danger’. Birth control had become increasingly available and, since the First World War, been practised by the working class.This was not least because of a labour market so hostile ‘that it seemed abject folly to produce children who could neither be adequately nourished nor sufficiently educated to secure a satisfactory livelihood’. But the authors also provided a solution to this problem, in essence the replacement of a competitive society by one driven by the principle, with Webb alluding to Marx,‘From each man according to his faculty, and to each man according to his need’. The latter was the principle carried out in the Soviet Union and ‘the authors suggest that, by the end of this century, its population may be some three hundred millions of well educated and healthy human beings’.2 Webb’s unthinking worship of the Soviet Union is evident here, and she was misleading about what the Titmusses had to say.They did provide an estimate of Soviet population by the end of the century as Webb described, but the comment about the health and education of that population was hers alone. Indeed,Titmuss and Kay were careful to point out that the projected growth in the Indian, Chinese, and Soviet populations was ‘fraught … with tremendous possibilities for good or evil for mankind’, and that Britain,‘and Western Civilisation generally’, could not ‘relinquish our responsibilities’. Having ‘slowly evolved a higher way of life’, it was the West’s duty, through ‘civilised leadership and not imperialism, by humanity and not imposition, by co-​operation and not competition’, to help ‘Asia and Africa along the road to full and free democracy’.3 These are noteworthy remarks, illustrating Titmuss’s concern for countries struggling with the consequences of rapid population growth, and the role which ‘Western Civilisation’ should adopt. More generally, Titmuss was immune to the Soviet Union’s charms, unlike many of his left-​wing contemporaries. Webb’s is, the necessary caveat aside, a fairly accurate summary of this relatively short (128 pages) book, which does not radically depart from Titmuss’s population concerns as already encountered. In their introduction, the Titmusses claimed to be ‘fully conscious that in the vast field of human life we have attempted to cover, generalisation has often had to replace scientific analysis’. It was hoped, too, that when peace returned, they could, in conjunction with François Lafitte, write a full-​length volume on the subject. For the present, they reiterated

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that the ‘reality of population is the root of all problems’, and that ‘we must look at things in terms of men and women, and not in terms of money’ –​a further rejection of contemporary capitalism’s acquisitive materialism. In a rousing conclusion, it was suggested that the ‘people of Britain have shown in an unmistakeable way by their refusal to reproduce that the existing social and economic order just will not do’. The ‘revolution in reproduction’ had been a silent one, so when would the ‘ordinary man [sic]’ break this silence? There was an urgency to this as ‘the hour is getting late and the future of the nation depends upon him’.4 The volume was immediately noted by the Eugenics Society. In a Eugenics Review editorial, Maurice Newfield asserted that it could be ‘recommended without qualification’. The book was ‘entertainingly written, well informed, stimulating and original’, and Newfield suggested that Kay’s ‘firm hand’ could be ‘detected in some highly successful efforts to present statistical material in a form assimilable by the ordinary reader’, a gentle critique of her husband’s occasionally dense prose. Newfield acknowledged that aspects of the work would ‘prove unacceptable to many eugenists’, by which he meant the traditionalist, hereditarian wing of the movement. But although the views expressed did not claim to be the Society’s policy, nonetheless they were consistent with it. Similarly, while there were differences of political opinion within the Society, and clearly referencing the current state of Europe, Newfield asserted that eugenics was a ‘philosophy for all men, all races, all classes’, and in Britain ‘all men do not, mercifully, hold the same political opinions’.5 The same edition also carried a more formal review by Lafitte. The volume was the ‘first really popular book … on the falling birth rate, its causes and consequences’.The conclusions reached were, essentially, those which the Population Investigation Committee had reached, namely that the question ‘Why do parents revolt?’ could only be answered in ‘social, moral and political terms’. Like the book’s authors, Lafitte consistently stressed the unwanted consequences of acquisitiveness, not least in that the ‘very nature of the social system inevitably compels family limitation’. Noting that the final chapter of Parents Revolt was entitled ‘The People Must Decide’, Lafitte concluded that few books ‘could be of more value in helping the people to decide’.6 Among other reviewers was the prominent radical Liberal, social worker, and social activist Percy Alden. Alden clearly liked aspects of the book, agreeing, for example, that there was ‘much truth in the contention that luxury consumption has been regarded in the past as a measure of the social status of the individual’. He endorsed, too, the

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notion that ‘we should first develop a social and economic atmosphere in which the right policy can succeed and in which parents will wish to have children’. If this ‘right policy’ could be secured internationally, wars would be ‘unnecessary’. What was missing, though, was an emphasis on education, since all the many measures which had been proposed ‘must necessarily fail until a truly educated democracy makes possible a standard of living which promises not only comfort but happiness for all’.7 So, a mixed review, and Oakley points out that this was true of the book’s reception in general, with, on the one hand, The Times suggesting that capitalism’s purported biological failure was an unproven thesis, while the professional journal Medical Officer argued that it should be read by all those working in the health services. But, as Oakley also remarks, the publicity arising from the book’s publication led to other opportunities for Titmuss to propagate his ideas, notably the radio broadcast discussed in the last chapter, ‘Too Few Babies’.8 Titmuss, although not without his critics, thus retained his position as an authority on population issues.

Titmuss and Churchill As the war came to an end,Titmuss contributed a chapter,‘The Statistics of Parenthood’, to a volume on post-​war family life edited by Sir James Marchant, an authority on birth control.The driving force here seems to have been Sir Arthur MacNalty, former Chief Medical Officer at the Ministry of Health, supporter of social medicine, and lead editor of the official medical history of the war. He and Titmuss were thus almost certainly well known to each other. In June 1945 MacNalty, on Marchant’s behalf, sent Titmuss a cheque ‘and our grateful thanks for your contribution to the book’. The King had accepted a copy of the volume, ‘and sends his sincere thanks to all the authors’. MacNalty noted that Churchill, in his recent election broadcast, had quoted from Titmuss’s essay.9 The Prime Minister had, indeed, lifted material from the piece. Population projections, he suggested, were one of the ‘new forms of prophecy’, but since they were mathematically based they ‘can be trusted’. So nobody ‘who cares about the future of our country should avert his eyes from the future of our population’.‘We are assured’, Churchill continued, ‘as a matter of practical certainty that this island will contain in 30 years time a far larger number of people over 65’. If, furthermore, married couples did not have more children than they were having before the war, then there would be a ‘far smaller number of men and women in their prime who have to bear the main burden in industry, in agriculture, and in defence’. So having children should

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be ‘a joy and not … a new burden’. None of this was, or should be, a party political matter, but rather one of national concern.10 The fact that Churchill broadcast on this issue again shows the widespread contemporary concerns about population growth and structure. So what did Titmuss himself say? Again, there was nothing especially new in his arguments, and Churchill had presented the salient points with reasonable accuracy. Suffice to say, then, that while Titmuss was rather more circumspect than the Prime Minister about the data involved, he had no doubt that British society could ‘no longer look ahead to any further significant additions to our total population’.11 And it was not only with Churchill that his essay struck a chord. A leading article in the BMJ reviewed the volume. It was ‘common ground’ among demographers that the population was not reproducing itself. Titmuss’s essay, moreover, gave a ‘much-​needed warning that a recent increase in the birth rate is, in all probability, a mere spurt explicable by wholly transitory conditions’.The situation as a whole made it ‘hard to close on a note of optimism’.12 A further indicator of the medical profession’s concern with this issue came in 1948 when Titmuss delivered the annual Lloyd Roberts lecture in Manchester.This lecture series had been endowed by the prominent Manchester doctor, David Lloyd Roberts, and given each year on a subject of scientific or medical interest. That Titmuss should have been asked to give this prestigious address is, again, testament to his rapidly growing fame and influence. More broadly,Titmuss’s lecture coincided with the inauguration of the social service he most admired, the NHS. He began with a historical survey of the family in industrial society, and this allowed for a nuanced approach to his subject, ‘Parenthood and Social Change’. For instance, because the family had shifted from being an economic unit to one concerned with protection and education, marriage had been liberated from the ‘authority of childbearing’. Parental decisions to limit family size had ‘banished a vast amount of distress’, and was hence ‘one of the major blessings of the 20th century’. Such decisions were, in turn, attributable to factors such as the ‘emancipation of women from the 19th century authority of men’. Nonetheless, there was another side to all this.The social environment wherein such decisions were taken had become increasingly hostile to the family, and a key question was why ‘the fear of too many people is so much more powerful than the fear of the consequences of a population declining in numbers, ageing in composition, and disinclined to replace itself ’.The situation was not helped by the belief that measures such as family allowances would ‘encourage the breeding of the unfit’, a pointed rebuttal of more traditional eugenicists’ views. Britain’s

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approach was in contrast to societies faced with similar problems, such as New Zealand and Sweden, and could in part be attributed to it being a country with a ‘strong caste system steeped in traditional values and accustomed to assessing social merit by social position’. New Zealand and Sweden were often cited, at this time, as egalitarian societies with relatively advanced welfare systems. So in the ‘hierarchy of values displayed by society parenthood continued to give place in choice and esteem to other goals, other pursuits, and alternative modes of living’. Once again, this was partly because society had acquired the ‘habit of considering the nation a collection of individuals and not of families’. Titmuss conceded that the recent introduction of family allowances and an expanded school meals service had been steps in the right direction, albeit not very large ones. But ‘the industrial system of reward for labour, which pays no regard to family responsibilities, continues to command approval’. It was thus a major part of the problem, and had to be addressed.13 Titmuss also critiqued various methods of collecting official data, and policies which he saw as actually inimical to family life –​as an example of the latter he cited the withdrawal of certain forms of allowance to members of the armed forces. So what was to be done? In terms of population, the choice lay between one of roughly the present size, but ‘not too over-​weighted’ with the elderly, and the gradual end of the British people. A ‘future of expanding numbers’ could be ruled out. It also had to be recognised, in social policy terms, that the future population would be smaller than it used to be, while acquiring greater ‘responsibilities and … anxieties’. In both medicine and education, contemporary thinking was ‘away from egocentricity and towards sociality; towards considering the individual as a social being; to thinking of him as a member of a family, a group, living in a particular environment, and working in a particular setting’. Such collectivist, organicist sentiment should ‘penetrate and inform all social policy’, and if the various new, or reformed, social services were ‘consciously guided, administered, and inspired by this philosophy, family life will be strengthened’. But, and this was the ‘core of the matter’, there should be no ‘fundamental contradictions in social policy as a whole’. Concluding,Titmuss suggested he had sought to show that the ‘area of contradiction and conflict stretches over much of our social and economic policy, not because we do not care about the family but because we do not think about the family’.14 As we know, Titmuss’s population predictions, at least in terms of absolute numbers, were wrong, with the UK population growing fairly steadily since the end of the Second World War. Ultimately

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more significant are, first, what Titmuss again insisted was the cause of the apparent decline in fertility, the moral corrosiveness produced in a society which measured individual worth in material terms. This discouraged childbearing, to the detriment of family life, and the life of society as a whole. The notion of the moral corrosiveness of society’s preoccupation with, as he saw it, merely economic factors, continued to be important to Titmuss, although his demographic obsession was quietly dropped. Second, his contention that women had been ‘emancipated’ in the twentieth century, not least through family limitation, was a topic to which Titmuss was to return on a number of occasions. Third, throughout Titmuss had been concerned not only with population as such, but also with population health, and how factors such as class and locality led to disparities in health outcomes. It is, therefore, appropriate to turn now to one way in which this developed in the mid-​1940s by way of his interest in, and role in creating, social medicine.

Social medicine So what was social medicine? In 1941, Jerry Morris described it as ‘the study of the social and economic relations of health and sickness’. This was not as straightforward as it might appear, for it was ‘only too easy to make loose generalisations’, a particular problem in the social sciences. It was, therefore, necessary to view the whole picture, to engage with the ‘social environment … as a whole’. More positively, though, ‘much disease and death are avoidable, because they are, in fact, being avoided by large sections of the community’. To illustrate his point, Morris then cited Titmuss’s work on infant mortality, and its variation by region, and by country.15 In a wide-​ranging survey of social medicine’s subject matter and history, published in 1947, the American public health authority and medical historian George Rosen, soon to review Problems of Social Policy favourably, argued that concern with social medicine had developed only slowly in Britain. But during the 1930s various factors had conspired to challenge both existing medical practice and the ‘powerful social ideologies still rooted in the nineteenth century’. Among the works exemplifying this challenge was Titmuss’s Poverty and Population (also cited by Morris), and Rosen added that this work’s subtitle, A Factual Study of Contemporary Waste, characterised the ‘point of view’ of most of the writers he had noted.16 In the longer term, though, we might also recall Titmuss’s admiration for the medical statisticians of the seventeenth century, John Graunt and William Petty.

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Nonetheless, social medicine in Britain is often associated with, in the first instance, the physician John Ryle, largely because it was he who took up the first Chair in the subject at the University of Oxford in 1943, in the same year publishing a programmatic statement in the BMJ. As he put it, social medicine was the same neither as socialised medicine nor as ‘preventive medicine as we now know it’ (by which he meant ‘public health’). Rather, it dealt with ‘the group as well as the individuals composing the group, with the many and varied problems created by sickness in the family and the community as a whole’. Social medicine thus embodied ‘the idea of medicine applied to man … as fellow or comrade’, with the aim of better understanding, and helping, the individual in respect of ‘all his main and contributory troubles which are inimical to active health and not merely to removing or alleviating a present pathology’. It likewise embraced the ‘idea of medicine applied in the service of … the community of men’, the aim being to lower ‘the incidence of all preventable disease’, so raising ‘the general level of human fitness’.As such, social medicine was a key element in the development of a ‘philosophy of scientific humanism’. In practical terms, all this involved teamwork, so those studying social medicine at Oxford were instructed not only by clinicians, but also by local social workers, and public health workers. This piece also cited Morris and Titmuss’s article on juvenile rheumatism, discussed below.17 More broadly, Ryle’s intervention was a contribution to contemporary debates about post-​ war reconstruction, and his stress on fellowship and comradeship was a reflection of wartime social solidarity. As Jane Lewis comments, social medicine’s emergence was part of a ‘social awakening among an academic and policy-​making elite that may well have encouraged Titmuss in his optimistic view of the wartime policy-​making process’.18 Ryle’s significance notwithstanding, Titmuss and Morris were important in advancing social medicine, and Ryle extensively referenced their work.19 In particular, three articles from the first half of the 1940s were crucial to the development of social medicine, and are discussed briefly below.20 First, though, what of the Morris–​Titmuss relationship? Morris was a Scot who undertook his medical education in Glasgow, where he was an active socialist, before moving to University College Hospital (UCH) London. He continued his political activities, being part of what he later called a ‘secret society’ of left-​wing doctors at UCH. This body was addressed by speakers such as Somerville Hastings, leader of the Socialist Medical Association and, as Morris put it, ‘a leading advocate of a national health service, which was then becoming very practical politics, very important’.The key moment came when Morris read Titmuss’s Poverty and Population,

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finding it ‘full of the kind of information I wanted’. He made contact. The two met by the entrance to Titmuss’s office (he was still working for the County Fire Office) and hit if off immediately, the start of a close, lifelong friendship.21 As Oakley records, Titmuss and Kay, and Morris and his wife, Galia,‘spent many happy times together over many years’, for instance in excursions into the countryside, with either Kay or Galia driving, neither Titmuss nor Morris having mastered that particular skill.22 The two men were among those who attended meetings of the Committee for the Study of Social Medicine, set up at UCH in 1939 with Philip D’Arcy Hart as secretary. Other members included Ryle, and Archie Cochrane, later famous for his advocacy of evidence-​based medicine.23 Collaborative work followed on the basis that, as Morris put it, Titmuss ‘didn’t know any medicine and was eager to learn, and I didn’t know any social statistics and was determined to learn’.24 Their collaboration, which involved skilful use of their existing contacts, was to continue, notwithstanding Morris’s posting to the Far East in the early 1940s with RAMC. This experience reinforced his belief in the need for social medicine. As he was to put it later, ‘if there was any place that needed social medicine it was India’.25 An important early outcome of their collaboration was the article on juvenile rheumatism, admired by Ryle, and a condition about which, Morris later recalled, he had ‘become obsessed as a medical student’.26 It is easy to see why the former admired the piece, and the latter had become obsessed. As Morris and Titmuss noted, juvenile rheumatism was the ‘least known of the great infectious diseases’, and especially problematic because of its implications for cardiac health. Its cause was unclear, it might be misdiagnosed, and its treatment was merely symptomatic. Addressing causal factors, Morris and Titmuss identified ‘damp and crowding, malnutrition and fatigue, lack of sunshine and holidays, inferior medical care, inadequate clothing and leaky boots … the whole life of the underprivileged child’ as responsible. In social medicine, ‘such multiple non-​specific causation is not unexpected’. One factor which could be ruled out, at this stage, was heredity. This was because any evidence pointing in that direction was scarce, and, in any event, ‘the disease is seen to be so sensitive to social inequality that emphasis on hereditary influences is premature’. The final caveat notwithstanding, this is not anything that a hard-​line eugenicist could sign up to (Morris was, in any case, highly sceptical about eugenics).The article concluded by reiterating that the ‘facts elucidated strengthen the view that the whole complex of poverty is involved in the production of juvenile rheumatism’.27 The message was clear –​treatment would cease to be symptomatic only when the underlying cause, poverty, was

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addressed. Morris later recalled that his first paper to the Committee for the Study of Social Medicine had been on juvenile rheumatism, the basis of the joint Lancet article.28 Shortly after the article appeared, Titmuss told Morris that he, accompanied by Galia, had attended a meeting at which Ryle had argued the case for socialised medicine. Moving on to social medicine, Ryle had singled out the Morris and Titmuss study. He and Galia were, understandably, ‘thrilled’.29 The second of the three articles, on peptic ulcer, noted the rising mortality rate, at least among men, but ‘workers in social medicine’ found the condition’s ‘main interest … the suffering and inefficiency it causes during life’. The situation was certainly complicated, with better off elderly men suffering higher mortality rates than those less well off. For younger men, duodenal ulcer showed no particular class bias, but deaths from gastric ulcer ‘associated with the manifold factors implicated in low economic status’. There were also, it seemed, issues to do with the nature of modern urban life, and the stresses it induced. Acknowledging the problem’s complexity, it was conceded that their study ‘asks more questions than answers’. But, with the ‘advance of social medicine’, there was ‘no reason why properly organised field studies should not replace much that at present is largely guesswork’.30 In the third piece, on rheumatic heart disease, and which built on that on juvenile rheumatism, the authors suggested that the ‘constantly changing interaction of health with society’ was ‘the base upon which social medicine rests’. In the particular case of the condition under examination, it had been shown that there was a ‘relationship between changing economic levels and a changing mortality rate’, with prolonged mass unemployment in the 1930s a factor of ‘considerable importance’.Their study had thus extended, and deepened, the ‘concept of [rheumatic heart disease, especially as it affected young people] as a social disease and, incidentally, as a most sensitive indicator of social conditions’. Using methods such as they had employed, ‘social medicine might eventually frame a series of laws governing the manifold dynamic interactions of health with society’.31 Ryle was not the only person to have taken note of Morris and Titmuss’s work. Stephen Taylor used their material in his 1944 book, Battle for Health: A Primer of Social Medicine, to illustrate his arguments about the social distribution of ill health.32 This was a particularly important instance of the acceptance of some tenets of social medicine in that Taylor was not only a clinician but also an increasingly important figure in the formulation of Labour Party health policy and, from 1945, a Labour MP. His biographer notes that Taylor was attached to the Ministry of Information during the war, where he initiated the

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wartime social survey, reflecting his interest in ‘post-​war planning and social medicine’.33 Titmuss had, in fact, commented on Taylor’s book, telling a Home Office official that it was ‘most impressive and original piece of work’ which should sell ‘on a large scale’. His only regret was that it had not mentioned ‘two of the diseases of the twentieth century –​patent medicines and peptic ulcer’. But the official should pass on his congratulations to Taylor.34

The Social Medicine Research Unit The peptic ulcer piece was to have an immediate and, for Morris and Titmuss, desired outcome. Throughout their wartime correspondence they had discussed how best to promote social medicine. As Shaun Murphy demonstrates, this began to bear fruit once the conflict was over, with the suggestion of Richard Schilling, a Medical Research Council (MRC) employee, that his organisation set up a Social Medicine Unit, with Morris as director and Titmuss as statistician. This led to MRC secretary, Edward Mellanby, meeting with Morris in October 1946. Mellanby had apparently been impressed by the peptic ulcer paper, and as a result of this meeting Morris and Titmuss produced a document in early 1947 arguing their case for social medicine. This was discussed, and agreed to, by MRC Council in spring, with the Social Medicine Research Unit, ultimately to be based at Central Middlesex Hospital, formally starting life in January 1948, just a few months before the inauguration of the NHS. The unit lasted until 1975, that is some 25 years after Titmuss’s departure. Its creation and early years can be seen as indicative of the optimism around social medicine, and social reconstruction, in the late 1940s.35 Thereafter, social medicine as a project lost its way. Nonetheless, as we shall see in Chapter 17, Titmuss and Morris attempted to insert some of its principles into the medical curriculum when the former was a member of the Royal Commission on Medical Education. To expand upon Titmuss’s involvement with the MRC, in December 1946 he sent Morris a memo containing his ‘Distilled Thoughts’. The two of them should ‘state what we should like to do and the principles by which we should be guided in doing it’.The problems they proposed to investigate, including tuberculosis and (again) peptic ulcer, had been selected because of their ‘present importance’, and ‘because of the possibilities of undertaking some practical research by utilising existing agencies’.36 Titmuss had anticipated some of this research not only through his existing publications but also by seeking data on tuberculosis from D’Arcy Hart, now himself at the MRC.37

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The ‘Distilled Thoughts’ formed the basis of the document Morris and Titmuss produced in January 1947, which proposed, as its first underlying principle, the ‘marriage of vital statistics with local social and medical enquiries’. Among the themes to be addressed was ‘Health in Middle Age’, and in particular the ‘social and occupational incidence of cardio-​vascular disease’. Concluding with a section entitled ‘Operational Research’, Morris and Titmuss suggested that ‘with the great body of new legislation’ –​a reference to the various Acts, including that which set up the NHS, currently being put in place –​ ‘some independent means will have to be found of assessing how new services actually work in terms of the individuals they concern’.38 In terms of staffing, Morris told Mellanby shortly thereafter that Titmuss, with whom he had worked, was a ‘suitable choice for the statistician’. Titmuss’s key publications, and current work on Problems of Social Policy, were noted and it was suggested that as a result of his ‘experience, ability and age’ a salary of around £1,000 per annum (over £40,000 in the twenty-​first century) would be appropriate. No further suggestions for staffing were needed at this stage, as the key figures were himself and Titmuss.39 This package was, as we have seen, successful, and in April 1947 Morris was informed of the council’s decision to support the creation of a unit ‘with yourself as Director and Titmuss as your chief colleague’. The project was initially approved for five years.40 As Oakley points out, MRC approval was a remarkably relaxed process, and Titmuss’s and Morris’s plans were ambitious and broadly based.41 Morris’s nonchalance about staffing notwithstanding, the unit’s first ‘Progress Report’ showed that it had, by 1950, 13 full-​time staff, five part-​time staff, and two ‘Attached Workers’ in receipt of Nuffield Fellowships, along with various support staff.42 In his application to the LSE for the Chair in Social Administration, Titmuss gave an account of his recruitment to the Social Medicine Research Unit, and his activities there. Partly because of the articles written with Morris, he had been ‘invited by Sir Edward Mellanby to join the scientific staff of the Medical Research Council’. In 1949, he had been made the unit’s deputy director, and his work focused on four areas: the ‘medical, biological and social factors in infant mortality and still births in England and Wales’, in conjunction with the General Register Office.The second was a ‘social and clinical study of stillbirths and neo-​natal deaths in London’, in conjunction with the LCC, while the third was a ‘field study’, in collaboration with Professor Baird of Aberdeen University, involving clinicians, dieticians, psychologists, and sociologists of the ‘reproductive performance among 2,000 mothers in Aberdeen’. Finally, there was a ‘field study of general medical practice’,

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which sought to define ‘the role of the general practitioner in relation to the total “health” needs of family groups’ in the broader context of the emerging ‘welfare state’. This was to be carried out with the cooperation of three GPs.43 To give a sense of Titmuss’s activities at the unit, we look briefly at the fourth of these projects, especially because general practice was a topic in which he had an ongoing interest. As Titmuss told a correspondent, a Dr Scott of the Usher Institute in Edinburgh, forms were to be sent to the three participating doctors, who would record basic information about their patient encounters.The knowledge acquired would be supplemented in three ways. First,Titmuss himself would, at intervals, be ‘sitting in the surgery and observing what goes on’. Second, he would, at several points during the year-​long project, ‘accompany the doctor and attempt a job analysis of his day’.Third, a social worker would visit around a hundred families to ‘ascertain illness experience’, and to assess medical need according to various criteria.Titmuss also looked forward to meeting with Scott when the latter visited London.44 A link with the Usher Institute would have been congenial to Titmuss. Previously a department of Edinburgh University with traditional public health concerns, the appointment of Francis Crew to a Chair in Public Health and Social Medicine in 1944 marked a shift towards the latter. In his inaugural lecture, Crew had argued that social medicine was a distinct academic field dealing with groups of humans beings. This marked it out from clinical medicine, as well as indicating that it would not be ‘circumscribed by what has come to be known as preventive medicine’, again the notion of a departure from public health as previously understood. Social medicine sought a positive engagement with the social sciences and could, thereby, become, as the lecture’s subtitle put it, both ‘An Academic Discipline and an Instrument of Social Policy’.45 These were sentiments sympathetic to Titmuss and Morris. The meeting with Scott duly took place, and Titmuss recorded the key points of their discussion. It is unclear whether these were exclusively his own views, but they accord closely with his approach to the health services in the 1950s, and his later critique of medical education. For instance, the 1949 notes suggested that it would not be enough simply to attach a social worker to GP practices. Rather, the doctor could not ‘escape facing the problems of sickness’, and must be the ‘conductor of the orchestra’. Many doctors, though, were reluctant to ‘step down from the practice of “scientific medicine” to inquire into and treat social sickness’, and to ‘take on the troublesome and time-​ consuming work of social case-​work and social therapy’. And doctors talked too much at the expense of listening to their patients.This arose

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for a variety of reasons, including as a coping mechanism for dealing with the ‘anxieties and responsibilities connected with life and death’.46 Although the survey was carried out, Titmuss was not directly involved in any publications from it, at least not immediately. But the need for doctors to listen to patients, and scepticism about aspects of ‘scientific medicine’, were to continue to be part of his critique of healthcare, and the medical profession’s practices. Titmuss’s approach corresponded closely with debates within medicine itself. We have noted that a holistic, or organic, approach underlay his social analysis. For those advocating holism in medicine, this was partly driven from the inter-​war period onwards by a concern for the ‘quality of human relations in clinical medicine’.This, in turn, was a response to ‘growing depersonalization and dehumanization of medicine and modern life more generally’, these being increasingly perceived as dominated by ‘technology, bureaucracy, and commercial relations’.47 A number of these issues were raised in a review by Titmuss (although published anonymously), produced in the early days of the Social Medicine Research Unit. This discussed Ferdynand Zweig’s book, Labour, Life and Poverty. Zweig was a refugee from Nazism, and formerly economic advisor to Poland’s wartime government in exile.Titmuss told The Lancet’s editor that the volume in question was a ‘very fine book’.48 His notice was consequently positive. Titmuss started by deprecating the trend to greater specialisation within society at the expense of ‘life itself with its constant changes, its unexpected turns, its immense variety and richness’.This trend was especially pronounced in economics and medicine. So to ‘bring us to our senses we need more men like Zweig’. His study of secondary poverty in London had succeeded in ‘giving us a wise and fascinating book about real men and real life’, particularly manual workers. Zweig’s book derived from ‘intimate and informal conversations’ with around 400 men in ‘places where people go for company or to which they drift by circumstance’. Specifically on the subject of manual workers’ health, ‘this Polish observer shows more insight than is apparent in most of the protracted argument about the need or otherwise for a new national health service’. Zweig’s text, and its methods and conclusions, thus stood in contrast to the ‘classifying, tabulating, slot-​machine mind, busy with its types and its textbooks, its questionnaires and its opinion polls’.49 Titmuss’s favourable review was in sharp contrast to the more general opinion among sociologists of Zweig’s work, which was considered, Mike Savage argues, that of a ‘disreputable populist rather than … a scholar’.50 Similarly, Helen McCarthy notes that Zweig, one of the earliest post-​war analysts of women’s labour market participation,

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stands out not only because of his subject matter, but also because of his ‘foreignness and his idiosyncratic research methods and prose style, which were frequently remarked upon disparagingly by reviewers’.51 The fact that Zweig analysed women’s employment, and was clearly viewed as an outsider, may have appealed to Titmuss, who likewise had an interest in women in the labour market, and was himself in a rather oblique position to academic social science (as, in a sense, he remained). Titmuss’s notice was notable, too, for its critique of professional overspecialisation, and the need to see individuals in their social contexts (just as in social medicine).These were issues to which he was constantly to return, especially in his analyses of healthcare. Zweig was understandably pleased with the review, telling Titmuss that they ought to form a ‘Society for Mutual Admiration’. ‘Your book’, he continued, ‘was a starting point which gave me the impetus to look after those hidden factors responsible for the very astonishing social development.’52 This was a reference to Birth, Poverty and Wealth, described by Zweig as ‘a most remarkable study’, and from which he drew upon data on excess infant mortality.53 The two apparently kept up their relationship, for in 1954, before leaving for an appointment at the University of Jerusalem, Zweig wrote to Titmuss ‘with my sincere thanks for your help and friendliness which you have always showed me’.54

Conclusion As we saw in Chapter 6, Titmuss was engaged with, and sometimes frustrated by, the production of Problems of Social Policy right up to its publication in 1950. This was, moreover, a finite project, and another source of income would, at some point, be required. The Social Medicine Research Unit provided, at that stage in Titmuss’s life, an ideal solution. Titmuss and Morris had established their credentials in the field, which, in turn, was closely aligned with Titmuss’s longstanding interest in population health. On a more ‘philosophical’ level, it also chimed with his holistic, organicist approach to human society in general, and his arguments for seeing individuals in their full, social context. But although Titmuss retained these interests and beliefs, his time at the MRC was to be relatively brief. The next chapter explains why. Notes 1 2 3

TITMUSS/​7/​79, letter, 25 November 1971, RMT to Lord Molson. R. and K. Titmuss, Parents Revolt: A Study of the Declining Birth-​Rate in Acquisitive Societies, London, Secker and Warburg, 1942, Preface, p 10. Ibid, pp 103–​4.

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RICHARD TITMUSS 4 Ibid, pp 12, 13, 123. 5 ‘Notes of the Quarter’, Eugenics Review, 34, 2, 1942, pp 52–​3. 6 F. Lafitte, ‘Population’, Eugenics Review, 34, 2, 1942, pp 70–​72. 7 P. Alden, ‘The Birthrate’, The Contemporary Review, 1 July 1942, pp 380–​81. 8 Oakley, Man and Wife, pp 166–​7. 9 TITMUSS/​7/​53, letter, 21 June 1945, MacNalty to RMT. 10 ‘Mr Churchill’s Second Broadcast: Building a Healthier Nation: Importance of British Strength in World Affairs’, The Times, 14 June 1945, p 4. 11 R.M. Titmuss, ‘The Statistics of Parenthood’, in Sir J. Marchant (ed), Rebuilding Family Life in the Post-​War World, London, Odhams, 1945, pp 19, 8. 12 ‘The Future of Populations’, BMJ, II, 1945, p 259. 13 R.M. Titmuss, ‘Parenthood and Social Change’, The Lancet, II, 1948, pp 797–​9. 14 Ibid, pp 799–​801. 15 Dr J.N. Morris, ‘Health and the Standard of Living’, The Highway, February 1941, p 83. 16 G. Rosen,‘What is Social Medicine? A Genetic Analysis of the Concept’, Bulletin of the History of Medicine, 21, January 1947, pp 721–​2. 17 J.A. Ryle, ‘Social Medicine: Its Meaning and Scope’, British Medical Journal, II, 1943, pp 633–​6. 18 J. Lewis, What Price Community Medicine?, Brighton,Wheatsheaf Books, 1986, p 35. 19 See, for example, the references in J.A. Ryle, Changing Disciplines, London, Oxford University Press, 1948; and J.A. Ryle, The Natural History of Disease, London, Oxford University Press, 2nd edn 1948. On the contribution of Titmuss and Morris, see the commentaries by M. Wadsworth and R. Illsley in A. Oakley and J. Barker (eds) Private Complaints and Public Health: Richard Titmuss on the National Health Service, Bristol, Policy Press, 2004. 20 On Titmuss and Morris in the early 1940s, A. Oakley, ‘Jerry Morris and Richard Titmuss: A Vision of Social Medicine’, Jerry Morris Memorial Lecture, LSHTM, 1 October 2019, available at https://p​ anopto.lshtm.ac.uk/P ​ anopto/P ​ ages/V ​ iewer. aspx?id=370af8ea-​e9d4-​48c1-​85c3-​aa64009109ed 21 Collated from ‘Professor Jerry Morris in Interview with Max Blythe, 9 May 1986’, typescript of the Royal College of Physicians and Oxford Brookes University Medical SciencesVideo Archive MSVA 008, pp 1–​5; andV. Berridge and S. Taylor (eds), Epidemiology, Social Medicine and Public Health, London, Centre for History in Public Health, LSHTM, 2005, pp 39–​40. Morris does not mention Hastings by name, but he was undoubtedly the speaker:  see J.  Stewart, ‘The Battle for Health’: A Political History of the Socialist Medical Association, 1930–​1951,Aldershot, Ashgate, 1999. For a profile of Morris, V. Berridge, ‘Celebration: Jerry Morris’, International Journal of Epidemiology, 30, 2001, pp 1141–​5. 22 A. Oakley,‘Appreciation: Jerry (Jeremiah Noah) Morris, 1910–​2009’, International Journal of Epidemiology, 39, 2010, p 276. 23 G. Watts, ‘Why a 1940s Medical Committee Should Not Be Forgotten’, BMJ, 323, II, 2001, p 360. 24 Berridge and Taylor, Epidemiology, p 40. 25 ‘Professor Jerry Morris in Interview with Max Blythe’, p 7. 26 Berridge and Taylor, Epidemiology, p 39. 27 J.N. Morris and R.M. Titmuss, ‘Epidemiology of Juvenile Rheumatism’, The Lancet, II, 1942, pp 59, 63. 28 ‘Professor Jerry Morris in Interview with Max Blythe’, p 5. 29 Oakley, Man and Wife, p 196.

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Population and family: Parents Revolt and the beginnings of social medicine 30 J.N. Morris and R.M. Titmuss, ‘Epidemiology of Peptic Ulcer: Vital Statistics’, The Lancet, II, 1944, pp 841, 845. On ulcers and stress see A. Haggett, A History of Male Psychological Disorders in Britain, 1945–​1980, Basingstoke, Palgrave Macmillan, 2015, p 30ff. 31 J.M. Morris and R.M.Titmuss,‘Health and Social Change I: The Recent History of Rheumatic Heart Disease’, The Medical Officer, Aug/​Sept 1944, pp 69–​71. This had been turned down by the BMJ. See Oakley, ‘Jerry Morris and Richard Titmuss’. 32 S. Taylor, Battle for Health: A Primer of Social Medicine, London, Nicholson and Watson, 1944, Chart IV and Table 20. 33 G. Rivett, ‘Stephen James Lake Taylor’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 34 TITMUSS/​7/​52, letter, 9 November 1944, RMT to S.C. Leslie. 35 S. Murphy, ‘The Early Days of the MRC Social Medicine Unit’, Social History of Medicine, 12, 3, 1999, pp 389–​406. Also A. Oakley, ‘Social Medicine and the Career of Richard Titmuss’, British Journal of Sociology, 42, 2, 1991, pp 165–​94. 36 MORRIS, JM/​14, R.M.Titmuss,‘Distilled Thoughts’, 6 December 1946, pp 1–​2. 37 TITMUSS/​7/​52, letter, 28 September 1944, D’Arcy Hart to RMT. 38 MORRIS, JM/​14, J. Morris and R.M.Titmuss,‘Formation of a Medical Research Council Social Medicine Unit’, 3 January 1947, pp 1–​3. 39 MORRIS, JM/​14, letter, 11 January 1947, Morris to Mellanby. 40 MORRIS, JM/​14, letter, 21 April 1947, A. Landsborough Thomson, MRC, to Morris. 41 Oakley, ‘Jerry Morris and Richard Titmuss’. 42 MORRIS, JM/​14, Medical Research Council,‘Progress Report 1948–​50 of the Social Medicine Research Unit’, p 1. 43 LSE Staff File/​Titmuss, ‘Application for the Chair of Social Administration’, 1950, p 1. 44 TITMUSS/​2/​99, letter, 16 December 1949, RMT to Scott. 45 F.A.E. Crew, ‘Social Medicine: An Academic Discipline and an Instrument of Social Policy’, Lancet, II, 1944, p 617. On the Usher Institute, and Crew’s transformative role, see U. Maclean, The Usher Institute and the Evolution of Community Medicine in Edinburgh, Edinburgh, Department of Community Medicine, 1975, pp 14ff. 46 TITMUSS/​2/​124, typescript, 22 December 1949,‘Notes on the GP after talking to Scott of Edinburgh’, pp 1–​2. 47 C. Lawrence and G. Weisz, ‘Medical Holism: The Context’, in C. Lawrence and G. Weisz (eds), Greater than the Parts: Holism in Biomedicine, 1920–​1950, New York, Oxford University Press, 1998, p 4. 48 TITMUSS/​7/​56, letter, 18 May 1948, RMT to T.F. Fox. 49 ‘Facts of Life’, The Lancet, I, 1948, p 836. 50 M. Savage, Identities and Social Change in Britain since 1940: The Politics of Method, Oxford, Oxford University Press, 2010, pp 165–​6. 51 H. McCarthy, ‘Social Science and Married Women’s Employment in Post-​War Britain’, Past and Present, 233, 1, 2016, p 281. 52 TITMUSS/​7/​56, letter, undated but spring 1948, Zweig to RMT. 53 F. Zweig, Labour, Life and Poverty, London,Victor Gollancz, 1948, p 117. 54 TITMUSS/​7/​62, letter, 19 March 1954, Zweig to RMT.

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10 The London School of Economics and ‘Social Administration in a Changing Society’ Introduction By the time of his LSE appointment, Titmuss’s reputation as a social scientist, historian, commentator on social affairs, and advisor to official bodies was well established. His work on population continued to resonate and led, for example, to an invitation to lecture on the subject at the University of Nottingham in late 1949.1 This suggests, too, that his findings were favourably viewed in at least some academic circles, a point further borne out by his ability to gain research grants, and to undertake work for bodies such as the MRC. Problems of Social Policy had finally been published in March 1950, and was well received. A further review, in The Times, was likewise upbeat. The anonymous reviewer (conceivably François Lafitte, employed at the paper since 1943, and its social policy expert) praised Titmuss’s ‘lucid account’ of the development of government policy suggesting, in a sentiment of which the author would have approved, that the ‘war was, in fact, the forcing house of the contemporary welfare State’.2 Such positive notices in the run-​up to his appointment can only have helped Titmuss’s cause.Titmuss also had a strong media presence, in both published and broadcast formats. He was by this point an experienced public speaker to a range of audiences. And, importantly,Titmuss was now extremely well connected. He knew, and had the backing of, the LSE director, Carr-​Saunders, as well as the influential support of colleagues such as Keith Hancock. In the very small world of British social science, this counted for a lot.

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In a curious incident which nonetheless flags up some of Titmuss’s key concerns, in spring 1948 he wrote to David Weitzman, barrister and Labour MP, who had been imprisoned for illegally supplying cosmetics, the production of which had been scaled down in wartime. His conviction was quashed on appeal, and Titmuss expressed his delight at the end of Weitzman’s ‘cruel and bitter experience’. The latter’s ‘courage and honesty in making a stand for prison reform’ was admirable, and Titmuss wished him well in his ‘efforts to make this new Bill a real reforming instrument’. This was a reference to what was soon to be the 1948 Criminal Justice Act. Titmuss then moved on to the broader implications of Weitzman’s experience, and what the latter was now trying to do. Complacency was ‘one of the greatest of evils’, and there were ‘too few protesting voices’ like Weitzman’s ‘helping to sustain our social conscience’. Titmuss had ‘read and learnt enough … to realise that we can and do manufacture the criminally minded –​especially among children and young people’.3 Titmuss’s fight against complacency, and for a social conscience, were to be two of the drivers of his activities, academic and public, as was his conviction that their environment profoundly shaped individual lives.

Coming to the LSE As Oakley notes, Titmuss’s appointment at the LSE in 1950 was his second attempt to enter that institution. In 1945 he had applied for a readership in Demography, but the successful candidate was David Glass, later Professor of Sociology.4 According to a letter from Walter Adams, School director at the time of Titmuss’s death, to Margaret Gowing when she was researching her obituary of Titmuss, the idea of his being a suitable person to take up the new Chair in Social Administration was first mooted in correspondence from T.H. Marshall to Carr-​Saunders.5 Marshall, in his obituary of Titmuss, noted that the ‘remarkable decision’ by the School ‘to establish a Chair in Social Administration, at a time when there was as yet no first degree in the subject, nor a foothold in any other degree’, had given Titmuss ‘his great opportunity’. Apart from formal academic qualifications,Titmuss ‘had everything one could ask for’.6 Marshall was, undoubtedly, a Titmuss supporter. He also had, though, more personal reasons for seeking a new professorial colleague. By the late 1940s Marshall was struggling with the duties required of him by the LSE. A Chair in Social Administration would relieve his workload, although, as Oakley notes, Marshall probably did not anticipate ‘the degree to which [Titmuss] would lead social administration so decisively away from sociology’.7 Was this a conscious decision?

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Titmuss had no problem with sociology as such, and was fond of citing, in particular, Émile Durkheim. But he was sceptical about the trend towards abstract theory in disciplines like sociology, and this was to become clear during, for example, ‘The Troubles’ which beset the LSE in the late 1960s. Given sociology’s intellectual trajectory by that point, and its standing at the School, this almost certainly contributed to the sense of alienation Titmuss sometimes felt from other parts of the institution. Carr-​Saunders ran with Marshall’s proposal, and the new post was duly advertised. A Board of Advisors was set up by the University of London, at this time a federal body of which the LSE was a constituent part, consisting of Douglas Logan, the university’s Vice-​Chancellor and Principal, Professor Sir Frederick Bartlett and G.D.H. Cole as external advisors, Barbara Wootton as internal University of London advisor, and five nominees from the School, including Carr-​Saunders, Glass, and Tawney.8 This was an impressive array of administrative and intellectual talent covering a broad spectrum of the social sciences. Logan, a lawyer, had taught at the LSE in the 1930s, and worked for the Ministry of Supply during the war. Bartlett was Professor of Experimental Psychology at Cambridge University, and a member of the MRC, so he would have known of Titmuss’s work. Cole was one of the leading political scientists of his day, and a prominent Labour Party member. Carr-​Saunders, Glass, and Wootton were personally known by Titmuss, as well as being leading figures in their respective fields, while Tawney was economic history’s elder statesman, and an intellectual inspiration to Titmuss. There were three candidates for the new post, but the board decided to interview only one, Titmuss.9 Consequently, in June 1950 Carr-​ Saunders wrote to Sir Otto Niemeyer, chair of the LSE’s Court of Governors and a director of the Bank of England, seeking the governors’ approval of the proposed appointment. Titmuss’s curriculum vitae was attached. ‘You will notice one thing odd about the recommendation’, Carr-​Saunders remarked, Titmuss’s lack of a degree. Carr-​Saunders agreed that this was ‘certainly unusual, but Titmuss is an unusual man’. He had worked his way up from being an insurance clerk ‘to a position of considerable reputation’. Indeed, he had already declined two offers of chairs that year, at the University of Birmingham and at the National University of Canberra.10 The School’s decision to appoint Titmuss was duly ratified by the senate of the University of London.11 The full title of Titmuss’s post was ‘Professor of Social Administration in the University of London’, to be held at the LSE. His salary was £1,800 per annum, nearly double what he was receiving at the MRC,

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and he was to take up his post on 1 October 1950.12 Titmuss was, at this point, still being paid, on a part-​time basis, by the Cabinet Office for editorial work on the official history of the social services during the war. He informed Carr-​Saunders of this, seeking permission to carry on with the work.This was agreed.13 Titmuss’s appointment was noted in that ‘Establishment’ mouthpiece, The Times.14 This prompted a letter from Leslie Farrer-​Brown, formerly a School administrator, now secretary of the Nuffield Foundation, and, during the war, seconded to the Ministry of Health. Farrer-​Brown told Titmuss that he ‘could not applaud this appointment more heartily. It is one of those one feels completely happy about’.15 Farrer-​Brown would have known of Titmuss through the Ministry, but also because the Nuffield Foundation had invested heavily in bodies with which Titmuss had worked or, like the British Sociological Association (BSA), was to work in the immediate future, or were associated with the LSE. This was notably the case with the Population Investigation Committee, which had received £25,000 over a five-​year period, one of the first social science awards made by a charitable body which clearly saw itself as having a vested interest in appointments such as Titmuss’s.16 For Noel Annan, leading member of what was coming to be called ‘The Establishment’,Titmuss’s success illustrated the School’s willingness, unlike Oxbridge, to take chances on new members of academic staff. ‘Where but at the LSE’ would have appointed Titmuss ‘when he had no degree nor educational qualification of any kind, since he had left school at fourteen?’17 Nonetheless, Robert Pinker suggests that at this point Titmuss had, Carr-​Saunders aside, ‘very few other friends and allies in the School’.18 More positively,Titmuss’s enhanced salary presumably facilitated the family’s move to a house in Twyford Avenue, West London, where he remained for the rest of his life, and is now marked by an English Heritage ‘Blue Plaque’. Ralf Dahrendorf, LSE director in the 1970s and 1980s, and School historian, described Titmuss’s appointment as marking the beginning of a ‘new era’ in what had been the Social Science Department (there were various name changes), headed up by Marshall, and which went on to become the Department of Social Administration, with Titmuss as its first chair. Dahrendorf stressed the department’s separation from the rest of the LSE in terms of what it taught (mostly social work and similar courses, with some 240 students when Titmuss arrived), and the fact that the overwhelming majority of its staff were women in an era when higher education teaching staff were overwhelmingly men. The high proportion of female students, and the vocational nature of their studies, meanwhile, infamously led to Titmuss being subjected

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to various jibes from colleagues from elsewhere in the School about the progress of his ‘good-​looking midwives’.19 Titmuss’s application to the LSE is worth examining briefly as it gives some insight into the image he wanted to present of himself in 1950. We noted in Chapter 2 his depiction of his origins, education, and early career. Titmuss also stressed his research prior to work on Problems of Social Policy, pointing out that, for instance, Lord Horder had provided a foreword for Poverty and Population. His successful application for a Leverhulme Research Grant to advance his work on social statistics, meanwhile, had been supported by Horder, and by the prominent statistician and economist A.L. Bowley. The latter had been an early appointment at the LSE, becoming one of its leading figures, as those reading Titmuss’s application would have been well aware. Titmuss outlined his work with Morris and the MRC on social medicine, and noted that The Lancet had praised their ‘important contributions’ in fields such as child rheumatism. At greater length, he also described his work for Hancock and the Cabinet Office. This involved not only his own research, but also the supervision of research assistants, and editorial involvement with other volumes in the series.Titmuss noted, too, his various lectures and educational activities, his work with the PIC (now effectively part of the School), the Lloyd Roberts lecture at Manchester, and his work with Dr (now Professor) Grundy on Luton, adding that the latter was prepared to answer any queries about this research. Publications were listed, and referees given, these being Hancock, Sir John Wrigley of the Ministry of Health, and, from the LSE, David Glass.20 Wrigley was a career civil servant who would have known of Titmuss from his work with the Cabinet Office. Glass, by the late 1940s one of the ‘demi-​gods of LSE’ by A.H. Halsey’s account, was also well acquainted with Titmuss, this time through their shared interest in population research.21 Latterly the two did not get on well, with one of those interviewed by Sonia Exley for her oral history of the Department of Social Policy remarking, with understatement, that relations between the two men were ‘not cordial’.22 Having said that, they had cooperated in the past and were to do so again in the future. In a practice which would later be frowned upon, Glass was both a referee for Titmuss, and a member of Board of Advisors. Titmuss’s application shows someone with the self-​confidence, and credentials, to promote himself to a particular, and intellectually gifted, audience. There is also a sense, though, that he was pushing at an open door. He had support from influential figures who knew how to exert that influence, and that he was the only interviewee suggests a foregone conclusion. So Titmuss had gained a place in academic life

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at the country’s most prestigious social science institution. But some caution is required here. The social sciences in post-​war Britain were not in an especially healthy position. The Clapham Report of 1946, instigated to look into the possible enhancement of social and economic research, found that in 1939 only 5 per cent of university professors were located in the social sciences, which attracted only 3 per cent of university research funding. By the late 1940s little had changed, and Mike Savage further states that, more specifically, what was notable was ‘the almost complete absence of sociology, the disciplinary dominance of economics, and the institutional power of the LSE’.23 The School was a big fish, but in a very small pond. Even at the LSE, by some accounts, social science had stagnated.A few months after Titmuss’s appointment R.J. Hammond, author of the official history of wartime food policy (another volume in the series to which Titmuss had contributed), wrote to him.The main point of the letter was to thank Titmuss for his help on Hammond’s own volume. But ‘I … ought to have written much earlier’, he continued,‘to wish you well at the LSE and to congratulate the LSE on having appointed you’. Hammond did not often go to the LSE any more, and it would ‘interest me to see what you think of the curious muddled legacy of the Webbs and the Charity Organisation Society that was the Social Science Department in my time’.24 Titmuss, it would seem, was going to have his work cut out.

Social Administration in a changing society A few weeks before Titmuss was formally offered the LSE post, he gave a talk, ‘Crossroads in Social Policy’, on the BBC’s Third Programme. This of itself was a reflection of his standing, for it was now part of the corporation’s strategy to engage leading scholars, so ushering in the ‘great age of the radio talk’.25 Titmuss argued that society, in an era of rapid change, had to make choices about where it was heading in social service provision. In the last decade  –​‘since the crisis of Dunkirk’  –​there had been an ‘immense broadening in the area of social responsibilities’, specifically in health, education, housing, food, and income maintenance. All this was expensive, hence the need for ‘social priorities’. Focusing on health, one point to be considered was who was to gain.The NHS undoubtedly ‘had been of great benefit to the middle classes and various professional interests’. It had provided ‘many more opportunities of employment in reasonably well-​paid jobs, permanent and pensionable, for the sons and daughters of middle class parents’.That the middle classes benefited disproportionately from the ‘welfare state’, in terms of both employment and services received, was

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to become a commonplace, but it is revealing that Titmuss saw it as an issue so early on.The ‘undoubted authority and prestige’ which medicine ‘commands today –​and this incidentally is a danger to medicine as well as to society –​is one reason why it will not be easy to settle in a rational way the problem of social priorities in the welfare state’. The growing power and influence of ‘the professional and technical classes’ was a problem in many social services, just as in the nationalised industries and local government. Nonetheless, while in general there were ‘real dangers in this growth of diploma worship and professional syndicalism’, these were ‘perhaps more serious in medicine than in other spheres’. Such developments were ‘tending to obscure the purposes’ for which the new social services had been created.26 Titmuss’s talk alerts us to the fact that, even in its early years, concerns were being expressed over the future direction of the ‘welfare state’. In healthcare, for example, there had been what Charles Webster describes as a ‘deluge of demand’ for items such as false teeth and spectacles, making it apparent that costs would not decline any time soon (and certain charges were to be introduced in the near future).27 This helps explain Titmuss’s phrase ‘social priorities’. The notion of a ‘crisis in the welfare state’ was notably articulated in two articles in The Times in 1952.These were unsigned, but expressed certain ideas with which Titmuss would have agreed, including the need to prioritise.28 There is no direct evidence that Titmuss wrote these pieces, although, as noted, Lafitte now worked for The Times, and may have commissioned his old friend. As we shall see in later chapters, from the early 1950s the Conservative Party was to question the funding of healthcare out of general taxation, while arguing for greater selectivity in the social services as a whole. Given that the Conservatives were in power from 1951 to 1964, and again in the early 1970s,Titmuss was going to have to challenge such ideas for a large part of his academic career. An important early step in Titmuss’s campaign for improved, and expanded, social services came on 10 May 1951, when he delivered his inaugural lecture, ‘Social Administration in a Changing Society’, the text being printed shortly thereafter in The British Journal of Sociology.29 The lecture allowed Titmuss to address four principal themes: how he construed ‘Social Administration’, a history of the department in which he now found himself, a history of the social services, primarily in the course of the twentieth century but with significant backward glances, and, finally, contemporary developments in welfare provision, and what Titmuss saw as problems inherent in its scope and delivery. It is the last of these to which most attention is devoted here but, given Titmuss’s historical cast of mind, the first three are briefly attended

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to. The address saw Titmuss name-​checking a large number of social scientists, doctors, social workers, and philosophers. Among these were the sociologists Karl Mannheim and Robert Merton, the psychiatrist Sigmund Freud,Tawney, the philosopher John Dewey, and the anthropologist Ruth Benedict.The novelists George Eliot and Daniel Defoe also got a mention. It is difficult to know what to make of this. Was Titmuss demonstrating to his audience that the LSE had acquired a well-​informed, and intellectually well-​rounded, social scientist? Was it standard academic practice at the time? Was he simply showing off? Or was it a manifestation of what some have seen as his social insecurity? Titmuss was acutely conscious that he had no formal educational qualifications, and perhaps never more so than when he was taking up a professorial chair at the University of London. So, what, by Titmuss’s account, was Social Administration? The days when it was primarily concerned with social work training were coming to an end. Its future was tied up with recent developments in social welfare, that is, the creation of the ‘welfare state’, with which the expansion of the field was inextricably linked. Social Administration’s subject matter embraced the social services in their historical and moral contexts, and their ability (or otherwise) to meet social needs. Especially notable here are Titmuss’s ongoing concern with placing welfare in its historical context, and with what he articulated as ‘the moral values implicit in social action’. It is equally clear that, for Titmuss, from now on his department should increasingly concern itself with research into, and teaching about, the social services, broadly defined. In promoting research, his aim was to heighten Social Administration’s academic profile, while arguing its relevance to the policy making process. On the second theme, the department’s history, it had been founded just before the First World War,‘a time when fundamental moral and social issues were being debated with vigour and a new sense of purpose’. Once more, the linkage of the moral and the social is striking.Titmuss also noted the contributions of such diverse individuals as Clement Attlee, T.H. Marshall, and Edith Eckhard.30 Attlee, his LSE and social work days behind him, was, at the time of Titmuss’s address, hanging on to power as Labour Prime Minister (although not for much longer). Eckhard, meanwhile, had effectively been running the department for some time, and Oakley notes how much Titmuss relied on her in his early days at the School.31 As to the history of the social services, even the ‘great collectivist advances at the beginning of the [twentieth] century’ –​that is, the 1906–​14 Liberal governments’ welfare reforms –​nonetheless had the ‘moral assumptions of the nineteenth century’. This was a reference

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to the Poor Laws with their ‘quasi-​disciplinary functions’, and which required of claimants that they behave, and behave thereafter, in a certain way. So if ‘poverty was a mark of waywardness then the poor needed moral condemnation or rewarding’. All this was, essentially, class-​based, with the middle and upper classes seeking to impose their morality and views of human nature –​‘metaphysical individualism’  –​on those beneath them. After the First World War, social services continued to expand, but in a rather haphazard way, and one in which ‘Classes of persons in need and categories of disease were treated’, rather than ‘families and social groups in distress’. Advances embodied, moreover, ‘political and social compromise’, and, as such, showed the ‘limit of reform which could be put into effect without upsetting the existing social order’. Setting up his discussion of the current state of the social services, Titmuss claimed that the ‘second great revolution of this century in social care’, begun with Dunkirk and accelerated after 1945, could, nonetheless, be seen as continuing pre-​existing trends.32 The last point appears out of step with the views we have seen him expressing, well into the 1950s, about the transformative early years of the Second World War. This is discussed further below. So what challenges now faced the social services? The very fact of the expansion of welfare provision had revealed ‘certain fundamental problems which were less obvious when the services were fewer and far less comprehensive’. These included issues such the quality, rather than simply the quantity, of provision available, and (again) how to prioritise need. Revisiting an issue already encountered, and one to which Titmuss repeatedly returned, he pointed to the expansion of ‘certain institutions and professional associations with their own self-​regarding interests’. Such professional associations, as they become more organised and influenced policy making, resented outside criticism, however valid. He was thus dismayed at the growing number of occupational groups ‘claiming professional status and rewards on the grounds of some specialized technique for which examinations and tests of competence multiply at an alarming rate’. Such workers also qualified for state-​ sponsored superannuation schemes which were costly, and inequitable, in that such provision was not available to everyone.Worrying, too, was that, expansion notwithstanding, many social services had ‘remained unchanged in structure, arrangement and administration both centrally and locally’. This in turn led to economic inefficiencies and administrative inflexibility.33 So when Titmuss spoke of the continuation of pre-​existing trends, what he meant was that while the social services had been revolutionised in scope, this was not necessarily so in terms

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of delivery, and the attitude of those doing the delivering.The need for empathy on the part of the latter was to be another recurring theme. In any event, the idea that the social services had ‘arrived at some sort of finality’ was misguided. All legislation was ‘experimental’, and welfare provision ‘a dynamic process –​not a finished article’. Among the challenges facing society was the need for professional associations to accept ‘greater social responsibilities’ to match the knowledge and power their position afforded them. Indeed, the ‘establishment of proper relations’ between such bodies and the ‘democratic State is, to-​day, one of the urgent problems facing the social services’. Other issues to be addressed included the implications for the elderly of diminishing family size, and who was to look after them as life expectancy increased. Inequalities in wealth, income, and life chances had, likewise, to be acknowledged and dealt with. More difficult to measure, but also important, were the ‘complex sicknesses of a complex society’. The effects of stress remained largely unknown, as were the ‘instabilities of family relationships or the extent of mental ill-​health in the community’.The social services had to be able to change in the face of broader social change. Similarly, his own area of study had to be flexible, for it ‘cannot hope to understand the working of social institutions and services without understanding the needs which arise for changing ways of living’.A balance between contemporary resources, and contemporary needs, would not be reached ‘by living-​out the destinies of tradition; by simply attending to the business of the State’. In a metaphorical final flourish,Titmuss suggested that ‘Without knowledge of wind and current, without some sense of purpose, men and societies do not keep afloat for long, morally or economically, by baling out the water’.34 Once again, morality raises its head, while the origins, and impact, of stress in modern life was another recurring theme. There was not necessarily anything new about the latter concern, but research over the previous two decades had added to an understanding of the condition. Among those contributing to this enhanced knowledge was Lord Horder, who in 1937 had argued that stress derived from, among other things, the ‘monotony and drabness of work’, an ‘increasing sense of international insecurity’, and the ‘anxiety connected with the competition of living’.35 As we have seen, Titmuss was expressing similar sentiments around the same time, and concerns about automation in the workplace and the consequent deskilling of the workforce were to inform his analysis of ‘The Affluent Society’ emerging by the late 1950s. One among the many impressed by Titmuss’s lecture was Richard Crossman. He recorded an informal meeting with other leading Labour figures, Hugh Gaitskell, Douglas Jay, and Roy Jenkins, in early 1952.

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The last three had come up with welfare policy proposals including an increase in old age pensions, as we shall see in Chapter 13 an important policy issue from around this time onwards. Crossman then ‘mentioned my reading Titmuss’s inaugural lecture, where he remarked that the purchasing power of unemployment and sickness benefit is now less than when they were first introduced’. Crossman, never one to hold back when confiding to his diaries, continued that ‘Gaitskell seemed surprised, as though it were a new idea that sickness benefit was low’. But this was confirmed by Labour’s social insurance experts, Edith Summerskill and James Griffiths, so sickness benefit was ‘added to the list’ of issues to address.36 Titmuss’s lecture, and consequent article, thus had an immediate impact. He thought it important enough to include in Essays on ‘The Welfare State’, published in 1958, while four years later Norman Franklin, of the British Journal of Sociology, wrote to ask if the piece could be included in an anthology of articles ‘of more general interest’ from the journal’s first ten years. Titmuss agreed.37 The journal had been founded in the same year as Titmuss’s appointment, Professors Marshall, Ginsberg, and Glass playing leading roles, with the BSA being formed the following year. Both had strong LSE links.38 Titmuss was fully involved from the start, serving as a longstanding member of the journal’s editorial board, and of the association’s executive, and as chair of the latter from 1959 to 1962. He also spoke at the BSA’s first conference, held in 1953, as part of a panel on health, his own contribution being ‘Social Needs and Costs: An Essay in Confusion’. The conference’s overarching theme was ‘Social Policy and the Social Sciences’. According to Marshall, this was a ‘significant’ choice, illustrating as it did ‘the practical application of the social sciences to the affairs of the contemporary world’.The keynote address came from the Swedish social scientist Gunnar Myrdal. Myrdal’s talk, ‘The Relation between Social Theory and Social Policy’, by Marshall’s account made a ‘profound impression’ on the meeting, not least in its emphasis on ‘values’.39 All this should be seen in the light of Savage’s observation that, in the early 1950s, sociology was seen as a ‘synthetic subject’, and that both the BSA and the journal drew heavily on contributions, and support, from other academic disciplines such as history, and economics. Sociology was, moreover, at this stage concerned with social reform as a moral project informed by citizenship, ideas associated with the likes of Tawney and Marshall.40 This was, then, as yet some way from the sociology of the 1960s and beyond, which saw itself as more methodologically rigorous, and ‘scientific’ –​as noted, not a development to Titmuss’s  taste.

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More positively, one of Titmuss’s appointees in the mid-​1950s, David Donnison, took the opportunity of his own professorial inaugural lecture to reflect on the field. Donnison noted the expansion of Social Administration into new, and challenging, areas. Such enquiries had ‘greatly extended and enlivened the scope of our subject since the first inaugural lecture was delivered upon it a dozen years ago’ –​that is in 1951. It was therefore appropriate that ‘so many of them should have been inspired by the man who delivered that lecture’. Donnison was also clear about what Social Administration, ‘an ill-​defined but recognisable territory’, should be about, namely ‘the development of collective action for the advancement of social welfare’.41 This was very much the Titmuss line but, again, some way from the purportedly more rigorous discipline of sociology.

Working in the department But how did the expansion of Social Administration at the LSE progress? In a talk marking the fiftieth anniversary of the founding of the Department of Social Science, Titmuss observed that in 1913 it had two staff devoted to teaching and research.This had grown to 13 by the time of his appointment, and to nearly 30 by the early 1960s. In terms of research outputs, since 1950 ‘fifteen major works based on original research’ had been published, and the series Occasional Papers in Social Administration launched, as had a social work journal.42 The journal was Case Conference, set up by Kay McDougall in 1954, while among the new members of staff were Brian Abel-​Smith and Peter Townsend. As Marshall later commented,Titmuss had a ‘flair for selecting brilliant colleagues, and his impressive assurance and magnetic personality … made them readily accept his invitation to join him and what soon came to be recognized as his circle’.43 None of this, though, came easy. From his appointment onwards, Titmuss constantly pressed the School for more resources. A letter to Carr-​Saunders a few months after his inaugural address gives a flavour of what he saw himself as being up against, alongside the sort of aspirations he had for the department. The context was a five-​year plan Titmuss had been asked to produce in advance of a meeting of the LSE’s Appointments Committee. Titmuss started on a downbeat note, remarking that his development plan was ‘not likely to be realised’ over the next five years. It was ‘difficult, possibly dangerous and perhaps impossible to make comparisons, and to say that the burden is heavier on the Social Science Department than in other departments’. Nonetheless, if it were any guide,‘I have recently had to tell Lord Lucan

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[Commonwealth Relations Office] that I could not release a senior member of my staff who had been invited to undertake a short lecture tour in New Zealand, and who wished to go’.Titmuss himself had had to abandon, for the foreseeable future, the proposed volume on the wartime social services which, as we know, was ultimately completed by others. He agreed that all this read like ‘self-​advertisement for the department’, although that was not his intention. But he had been ‘compelled to state some of the facts if the staffing problem of the department is to be seen in a broader perspective’. So if the department had to ‘look to the next five years with the prospect of little or no relief ’, restrictions would have to be imposed, since ‘we have no intention of lowering the present standard of teaching’. Among the potential cuts was ending instruction for senior civil servants. In ‘placing these facts before the Appointments Committee’, he would, therefore, urge that ‘no decisions on other claims be taken … until the claims of the Social Science Department have been weighed alongside’ these, and in ‘relation to the changing nature of student needs in the School as a whole’.44 Most heads of academic departments spend much of their time chasing resources, hinting (or more) that they, and their colleagues, are ill-​served compared to others, and implying unwelcome consequences if their demands are not met.Titmuss had joined the club. Nonetheless, he may have had a point. The School Calendar for 1951–​52 shows that some 15 courses in ‘Social Science and Administration’ were being offered contributing to, variously, the BA in Sociology, the one-​ and the two-​year Social Science Certificate courses, the Personnel Management course, and the Certificate in Mental Health. Titmuss himself led ‘Introduction to Social Policy’, ‘Health and the Health Services’, and the ‘Seminar on Social Administration’.There were also ten classes for the ‘Course for Social Workers in Mental Health’, and seven in Child Care, some of which were taught by non-​LSE staff, but which still had to be administered.45 As Titmuss had implied in his letter, the LSE’s finances were stretched in the early 1950s, and the five-​year plan starting in 1952 prioritised existing, severe, accommodation problems. Perhaps confirming Titmuss’s suspicions, it was noted that the LSE sought to ‘cultivate more intensively those fields of study that are already within its territory, especially history and philosophy, rather than to enlarge the area of study’.46 Titmuss had been appointed to a specially created chair. In his inaugural lecture he had outlined his ambitions for Social Administration, a field of increasing interest in the era of the ‘welfare state’. But there were institutional constraints, and it is to his credit, and an indicator of his persistence, that he did

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expand the field so successfully while, despite his repeated grumbling, remaining loyal to the School. He was also capable of using his own position to disengage with projects with which he had become uncomfortable. In 1947 the Eugenics Society had funded a study group, the Problem Families Committee. Titmuss was one of its original members, as were Horder and Blacker. Shortly after his LSE appointment, however, he told Blacker that, since he had ‘been able to give so little time and attention to the Problem Families Committee’, he was going to resign. Blacker, in response, expressed the hope that Titmuss would not do so, adding that, since the committee’s work was almost complete, any further business could be conducted by post.Titmuss stuck to his guns, telling Blacker, in a further letter, that his problem was that ‘I find I now have so many additional commitments (all of which, as I know you realise, involve a lot of reading) that somehow or other I  must relinquish some of them’. Blacker was clearly not pleased. Nonetheless, he told Titmuss, in late 1951, that the committee’s report was nearly finished. Would Titmuss like his name to be listed on it as a committee member? Titmuss replied that, overall, ‘as I  have not been able to contribute anything to the work, I think it would be misleading to associate my name with the report’.47 This exchange shows, first, that Blacker continued to hold Titmuss in high esteem, and was anxious to have him associated with the Problem Families Committee. Equally,Titmuss had taken on a job for which he had no previous training or experience, and was deluged by demands on his time, institutional and self-​imposed. As Welshman shows, he was also, by this point, keen to distance himself from the Problem Families Committee, both on methodological grounds, and because of his own belief that there should be greater emphasis on rehabilitation when dealing with families deemed troublesome.48 Titmuss may genuinely have felt that certain commitments had to go on his arrival at the LSE, although it is interesting to note that he continued to help the PIC, for instance by reading a manuscript on the demography of New Zealand in early 1952.49 But he also was willing to use his new commitments as an opportunity to step away from projects with potentially disagreeable outcomes.

Conclusion It is frequently remarked of Titmuss, and has been since his appointment, that he came to the LSE with no formal educational qualifications. But he did not come from nowhere.Titmuss had influential friends, a public

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profile, and a record of published research which would have shamed many more conventional academics. On his arrival at the School, he articulated his vision of a new direction for Social Administration. From this platform, and in due course with the support of, in particular, his own appointments, he would go on to shape the field of Social Policy, as it came to be known, around his core beliefs and concerns.The next part of this volume further discusses his activities in the first ten years or so of his LSE career, beginning with a chapter on a number of other ways in which he laid out his social analyses and programme for social change. Notes 1 TITMUSS/​7/​58, letter, 13 October 1949, F.A.Wells, University of Nottingham, to RMT. The lecture duly took place on 9 December 1949. 2 ‘Official War History: War as a Forcing House of the Welfare State’, The Times, 20 March 1950, p 5. 3 TITMUSS/​7/​56, letter, 29 April 1948, RMT to Weitzman. 4 Oakley, Father and Daughter, p 115. 5 LSE/​Staff File/​Titmuss, letters, 23 and 24 July 1973, Adams to Gowing. 6 T.H. Marshall, ‘Richard Titmuss: An Appreciation’, British Journal of Sociology, 24, 2, 1973, p 137. 7 A.H. Halsey,‘Thomas Humphrey Marshall’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004; Oakley, Father and Daughter, pp 114–​15. 8 LSE/​Staff File/​Titmuss, memo, ‘Chair of Social Administration at the London School of Economics’, nd, but summer 1950. 9 LSE/​Staff File/​Titmuss, letters, 23 and 24 July 1973, Adams to Gowing. 10 LSE/​Staff File/​Titmuss, letter, 12 June 1950, Carr-​Saunders to Niemeyer. 11 LSE/​Staff File/​Titmuss, letter, 20 June 1950, Logan to RMT. 12 LSE/​Staff File/​Titmuss, ‘University of London: Chair of Social Administration at the London School of Economics’, nd, but summer 1950. 13 LSE/​Staff File/​Titmuss, letters, 20 August 1950, RMT to Carr-​Saunders, and 22 August 1950, Carr-​Saunders to RMT. 14 ‘University News’, The Times, 11 July 1950, p 6. 15 TITMUSS/​7/​58, letter, 11 July 1950, Farrer-​Brown to RMT. 16 The Nuffield Foundation, First Report, London, The Nuffield Foundation, 1946, p 38. On Nuffield support for the BSA, see J. Platt, ‘The History of the British Sociological Association’, International Sociology, 17, 2, 2002, p 182. 17 N. Annan, Our Age: Portrait of a Generation, London, Weidenfeld and Nicholson, 1990, pp 6–​7. 18 R. Pinker,‘Richard Titmuss and the Making of British Social Policy Studies after the Second World War: A Reappraisal’, in J. Offer and R. Pinker (eds), Social Policy and Welfare Pluralism: Selected Writings of Robert Pinker, Bristol, Policy Press, 2017, p 95. 19 Dahrendorf, A History of the London School of Economics, p 380ff. 20 LSE/​Staff File/​Titmuss, RMT,‘Application for the Chair of Social Administration’, nd, but 1950. 21 A.H. Halsey, No Discouragement:  An Autobiography, Basingstoke, Macmillan, 1996, p 58.

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RICHARD TITMUSS 22 LSE, Department of Social Policy, Oral History Project, Professor Robert Pinker interviewed by Sonia Exley, 30 November 2012. 23 M. Savage, Identities and Social Change in Britain since 1940: The Politics of Method, Oxford, Oxford University Press, 2010, p 119ff. The social sciences embraced anthropology, economics, sociology, social psychology, social science, economic history, commerce, and politics. 24 TITMUSS/​7/​58, letter, 9 October 1950, Hammond to RMT. 25 B. Harrison, Seeking a Role: The United Kingdom, 1951–​1970, Oxford, Oxford University Press, 2009, p 395. 26 TITMUSS/​4/​566, typescript, nine pages, ‘Crossroads in Social Policy: A Talk by Richard M. Titmuss’, broadcast on the Third Programme, 31 May 1950, pp 6–​9. 27 C. Webster, The National Health Service:  A Political History, Oxford, Oxford University Press, 2nd edn 2002, pp 29–​30. 28 Our Special Correspondent, ‘Crisis in the Welfare State: I –​The “Beveridge” Principles’, and ‘II – Ends and Means’, The Times, 25 February 1952, p 7, and 26th February 1952, p 5. 29 Titmuss, ‘Social Administration in a Changing Society’. 30 Ibid, pp 183, 184, 185, 186. 31 Oakley, Father and Daughter, pp 112–​13. 32 Titmuss, ‘Social Administration in a Changing Society’, pp 186–​7, 188, 189. 33 Ibid, pp 189–​92. 34 Ibid, pp 193–​4, 196–​7. 35 M. Jackson, ‘The Stress of Life: A Modern Complaint?’, Lancet, 383, I, 2014, pp 300–​301, Horder cited at p 300. 36 J. Morgan (ed), The Backbench Diaries of Richard Crossman, London, Hamish Hamilton/​Jonathan Cape, 1981, entry for 14 February 1952. 37 TITMUSS/​7/​70, letter, ? February 1962, Franklin to RMT; and letter, 21 February 1962, RMT to Franklin. 38 J. Platt, The British Sociological Association:  A Sociological History, Durham, sociologypress, 2003, pp 20–​21. 39 T.H. Marshall, ‘Conference of the British Sociological Association, 1953. I Impressions of the Conference’, British Journal of Sociology, 4, 3, 1953, pp 201–​9. 40 Savage, Identities and Social Change, p 106ff. 41 D.V. Donnison, The Development of Social Administration: An Inaugural Lecture by D.V. Donnison, London, London School of Economics/​G. Bell and Sons, 1962, pp  20–​21. 42 R.M. Titmuss, ‘Time Remembered’, in Commitment to Welfare, pp 50–​51. 43 Marshall, ‘Richard Titmuss’, p 137. 44 TITMUSS/​7/​59, letter, 7 December 1951, RMT to Carr-​Saunders. 45 The Calendar of the London School of Economics and Political Science, 1951–​52, London, LSE, 1951, pp 330–​38. 46 Dahrendorf, A History, p 374. 47 TITMUSS/​4/​545, letters, 14 November 1950, RMT to Blacker, 15 November 1950, Blacker to RMT, 17 November 1950, RMT to Blacker, 21 November 1950, Blacker to RMT, 27 December 1951, Blacker to RMT, and 3 January 1952, RMT to Blacker. 48 J. Welshman, Underclass: A History of the Excluded since 1880, London, 2nd edn 2013, p 83ff. 49 TITMUSS/​4/​546, Minutes of a Meeting of the Population Investigation Committee, 11 March 1952.

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Part 3

FIRST DECADE AT THE LSE

11 Setting out his stall Introduction By the mid-​1950s Titmuss’s reputation was spreading abroad. For instance, in 1955 he was asked by the Technical Assistance Department of the United Nations to take part in seminar, in Vienna, on comparative social research.1 As we shall see in a later chapter, by this point he was also becoming well known in the United States. Here we examine four public addresses from the first half of the 1950s. In 1952 Titmuss delivered the Millicent Fawcett Lecture, in 1955 the James Seth and the Eleanor Rathbone Lectures, and in 1956 he spoke at the International Conference on Social Work. The first, second, and fourth of these were reproduced, in 1958, in Essays on ‘The Welfare State’. Although the Rathbone Lecture and the social work talk had already appeared in print, they had done so as a Liverpool University pamphlet, and in a rather obscure American professional journal. The Fawcett Lecture was previously unpublished. The Seth Lecture, given in Edinburgh, is included because of its insights into the ‘philosophical’ background to Titmuss’s approach to welfare. These were far from the only public addresses Titmuss gave in this period, and we shall variously encounter others. But each was important both in its own right, and as illustrating central themes in Titmuss’s thought as he sought to develop a ‘philosophy of welfare’ in his early years at the LSE. A brief summary of the four speeches is given, followed by an attempt to draw out the main points Titmuss sought to make.

‘The Position of Women’ Titmuss’s Millicent Fawcett Lecture, ‘The Position of Women: Some Vital Statistics’, was delivered at Bedford College, London, in early 1952.

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Topics of this sort, and what was seen as the associated issue of the role and future of the family, were clearly popular in this period. Equally clearly, Titmuss was a leading contributor to these discussions. A few days before his Fawcett Lecture, for example, he addressed London County Council staff on ‘The Family and the Welfare State’.2 Bedford College was particularly appropriate for Titmuss’s 1952 address, as was the lecture series to which he contributed. The student body was all-​ female, while Millicent Fawcett had been a prominent campaigner for women’s voting rights. Bedford College was also where Titmuss’s friend, Barbara Wootton, was at this point having a difficult time as a member of staff.3 The lecture started with the observation that, at a time when ‘the possibilities of progress and the practicability of applied social science are being questioned’, it was satisfying to recall some of the achievements of Britain’s Women’s Suffrage Movement.The movement and its leaders, including Millicent Fawcett, had been the subjects of historical investigation, although the lives of working class women, and especially mothers, had been largely neglected. Consequently, women’s position in modern society had been analysed primarily by ‘the psychologist, the psychiatrist and the sexologist’.4 The superficially rather strange reference to ‘the sexologist’ almost certainly alludes to various post-​war investigations into marital relationships.5 The changes which had occurred, though, presented ‘the makers of social policy with some new and fundamental problems’.Titmuss then focused on population matters. The ‘fall in the birth rate in Western societies’, for example, was ‘one of the dominating biological facts of the twentieth century’. It had, for the most part, occurred because of a ‘revolutionary change in working-​class attitudes to childbearing’. All this had profound implications for women, especially when combined with greater life expectancy. For instance, and unlike in the past, nowadays a woman’s ‘maternal role’, in the sense of being directly responsible for childrearing, was generally finished by the age of 40. This left her another 36 years of life, almost half her life expectancy. For industrialised societies based on an ‘extensive division of labour, on the early acquisition of occupational skills, on the personal achievement of status through educational and other channels which steadily narrow after the first ten years of adult life’, all this presented ‘a host of new social problems’. Taking an issue close to his heart, Titmuss pointed out that given women’s increased life span, and ongoing improvements in women’s health at a much better rate than for men, there was ‘no justification … for a lower pensionable age for women’. As to family dynamics, ‘it can be said with some degree of truth that the mutual relationships of husband and wife are very different today from the

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picture of married life which emerges from the literature and social investigations of Edwardian times’  –​that is, only a few decades previously.6 On marriage,Titmuss’s data revealed that not only was there more of it, but that individual marriages were lasting longer. That married life had been ‘lengthened not only by declining mortality but by earlier marriage’ was a ‘fact of the greatest social importance’.The ‘statistics of marriage’ further revealed that, as touched on earlier, there had been a ‘concentration of family building in the earlier years of life’, and, as a result of the duration of modern marriages, a ‘substantial expansion in the years of exposure to the strains and stresses of married life’. All this had taken place against the background of ‘increasing emancipation for women’. Titmuss then identified what he saw as the paradox of ‘fewer social and legal restraints and more equality and freedom for women’, alongside ‘an increase in the popularity of the marriage institution’. Examination of the statistical data thus suggested that the ‘question of the rights of women to an emotionally satisfying and independent life appears in a new guise’. How, for example, was appropriate training and entry to the labour market to be addressed given that, as matters stood, there were almost unsurmountable barriers to women whose immediate childrearing responsibilities had come to an end? To make matters worse, there was the question of whether mothers should be re-​entering the labour market at all.There were few subjects ‘more surrounded with prejudice and moral platitude’, which in turn might deepen ‘the conflict for women themselves about their roles as mothers, wives and wage-​earners’.Titmuss concluded that in the ‘field of employment opportunities, as in so many other fields, new issues for social policy are taking shape as a consequence of these changes in the position of women in society’. So whereas the ‘problems for State policy’ raised by the Edwardian women’s movement were primarily political, ‘those raised by the women’s movements of today are largely social’.7 Helen McCarthy points to one of the more immediate outcomes of this speech. Citing the passage in which the idea of changes in women’s position raised questions about ‘the rights of women to an emotionally satisfying and independent life’, McCarthy shows that this led to Titmuss gaining, in 1956, a large grant from the Department for Scientific and Industrial Research to investigate married women in employment in South London. With Titmuss’s encouragement, a further study, similarly funded, was undertaken in Leicester.8 The results of the London study, based at a biscuit factory in Bermondsey, were published in 1962.Titmuss had not undertaken the research himself, but the book’s authors recorded that their research had been done ‘under

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the direction of Professor Richard Titmuss’. Titmuss also contributed a foreword which noted the complexity of the issues under investigation, concluding that we ‘cannot understand the wife who goes out to work nor, we should add, the husband who goes out to work, unless we also understand at the same time the changing place of the family in modern industrial societies’.9 As McCarthy further points out, this volume sits alongside the work of Ferdynand Zweig, whom we met in Chapter 9 by way of Titmuss’s favourable review of one of his works.10

North of the border In Edinburgh, three years after the Fawcett Lecture, Titmuss spoke on ‘The Social Services’ in the lecture series named after the Scottish philosopher James Seth. Seth took up the Chair in Moral Philosophy at Edinburgh University in 1898, holding this post for the next 26 years. Philosophically, Seth was an idealist and, as Jose Harris points out, he, like others of this school of thought, played an important role in setting up social science departments in British universities. Seth’s view on state-​provided social services was, as Harris shows, that they should be ‘not only freely available but compulsory’. One of Seth’s contemporaries, the prominent idealist philosopher E.J. Urwick, was the founder of the LSE Social Science Department. Urwick argued that this should concern itself with ‘social philosophy’, rather than simply social science or sociology. This, Harris suggests, involved the ‘evaluation of social institutions in the light of a “pattern” of immutable ethical truths’. In an intriguing remark, she further claims that Titmuss was Urwick’s ‘apostolic successor’, and that the former’s ‘social philosophy … was full of muffled resonances of the idealist discourse of the Edwardian age’.11 Important arguments have been made specifically identifying Titmuss as subscribing to idealist philosophy, an approach which embraced, among other things, a belief in the organic nature of society, and the moral purpose of social policy.12 We have already encountered such arguments in examining Titmuss’s relationship to inter-​war progressive thought, and his critique of ‘The Acquisitive Society’, and shall do so again.The first James Seth lecture had been given by Sidney Webb in 1929, and subsequent speakers included Clement Attlee and Titmuss’s adversary in the LSE social work dispute, Eileen Younghusband. Later speakers were to include colleagues such as Robert Pinker and David Donnison. Donnison, too, remarked on Seth’s role in setting up Edinburgh’s Department of Social Administration.13 In short,Titmuss’s first lecture in Edinburgh took place in an especially congenial intellectual setting.

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So what did he tell his Edinburgh audience in 1955? Giving an immediate sense that understanding the aims, and outcomes, of contemporary social services was, in fact, uncharted territory, Titmuss asserted that the ‘maps most of us use’ were outdated. Most notably, Beveridge was a ‘better guide to the 1930s than the 1950s’. Moreover, the world of the social services ‘as a separate, autonomous entity does not exist’. In other words, it was, or should be, an integral part of society. He then moved on to how social services were presently conceived, and began with one of his bugbears, the phrase ‘welfare state’. This evoked ‘the image of paternalism at the summit of its achievement’. It was, then, an account of social service development which adopted a ‘whiggish’ historical approach, that is, one which saw relentless progress as the principal organising factor in English history. But this was an illusion, for to ‘imprison, metaphysically, the social services in this historical framework of progressive benevolence’ was among the reasons ‘why we have no clear understanding of the roles being played by the services in the reality of today’.14 What sort of understanding should be sought? Taking the example of the stresses of modern life,Titmuss claimed that the greater the comprehension of their nature and outcomes,‘so, in proportion, do the ethical issues in social policy become more explicit and complex’. Increased knowledge of human psychology meant that ‘we know more about pain’, its origins, and its outcomes in behavioural terms.This enlightenment explained the ‘revolution that has taken place since the nineteenth century in attitudes to the child’. Knowing more about pain likewise partly explained modern Britain’s ‘welfare society’. Such knowledge influenced relationships, because a ‘heightened sensitivity to the pain of others implies a heightened sense of felt responsibility for its alleviation and removal’, and so the ‘meaning of a “welfare society” –​the promise it holds out –​is that some pain is avoidable’. Science had thus broken the link between ‘goodness’ and ‘suffering’. That is, it was no longer acceptable to suggest a relationship between ‘suffering’ and what was deemed questionable behaviour. Consequently,Titmuss suggested that policies and practices to ‘counter the “disservices” caused by change have acquired a variety of names under which an even greater variety of roles are played’. Such roles could not be simplistically reduced to categories such as poor and rich, benefactors and beneficiaries. Rather, they reflected ‘the nature of the society in which we live, the demands it makes, and the needs which it creates’. And so the social services, ‘as means and not ends’, reflected the ‘kind of society we choose to live in today and, in even stronger colours, the kind of society in which we lived yesterday’.15

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‘The Social Division of Welfare’ The other major speech of 1955, given on 1 December at the University of Birmingham, was the sixth Eleanor Rathbone Memorial Lecture, ‘The Social Division of Welfare: Some Reflections on the Search for Equity’. Discussing the outpouring of investigations into the working class in the 1950s and 1960s, which included the work of Richard Hoggart, Michael Young, and Abel-​Smith and Townsend, Paul Addison describes Titmuss’s Birmingham address as a ‘landmark lecture’.16 It was certainly to be among his most famous, and innovative, contributions to his field, and one still referred to over half a century later. Because of this lasting significance, particular attention is paid to this speech. The lecture series had been set up to address subjects with which Rathbone’s name ‘was particularly associated’. Earlier lecturers had included the prominent Labour politician (and, from December 1955, party leader), Hugh Gaitskell.17 Titmuss evidently felt his talk to be of significance from the outset, telling Eveline Burns, an American friend, that he had ‘been working on a long and complicated paper (ambiguously entitled “The Social Division of Welfare”) which I have to give as the Rathbone Memorial Lecture next month’.18 So what did this ‘long and complicated’ address say? Titmuss started by noting his own relationship with Rathbone, which as we have seen started before the Second World War when he helped her with her work on family allowances, and that he wanted to ‘renew our testimony to a remarkable and gifted person by pursuing some of the ideas which she put forward in her studies of “the disinherited family” ’. This was a reference to Rathbone’s work of 1924, an early statement of the demand for what became, ultimately, family allowances. Titmuss’s present agenda was to relate Rathbone’s insights to ‘certain aspects of social change’ which called for a ‘re-​examination of the concept and roles of social welfare in modern society’. The introduction of family allowances, he argued, was frequently portrayed as part of a particular historical narrative of the coming of the ‘welfare state’, a ‘unilinear progression’ wherein, over the preceding century, a ‘broad, ascending road of social betterment’ had been provided for the working classes.This view of the ‘welfare state’ was held by both major political parties, and so there might be a general assumption that Britain was ‘approaching the end of the road of social reform’. More than this, though, recent criticism of the ‘welfare state’ suggested that it had gone too far, too fast, with harmful consequences for both the economy and the nation’s ‘moral fibre’. By such accounts, the working classes received services they did not actually need, paid for by the squeezed upper and

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middle classes. Here Titmuss cited the rising Conservative politicians who were to be among his most enduring welfare adversaries, Enoch Powell and Iain Macleod. By this account, what was required was the employment of rigorous actuarial principles.The ultimate aim of those social services not delivering direct cash benefits, moreover, should be ‘self-​liquidation’, as rising prosperity allowed more and more people to make their own arrangements for the private provision of, say, healthcare and education. Given the social values involved, the ‘welfare state’ would thus mutate into the ‘Middle Class State’.19 Titmuss was having none of this, although he acknowledged that such views had helped to produce ‘in the public eye something akin to a stereotype or image of an all-​pervasive Welfare State for the Working Classes’.This was paradoxical in that ‘this idea of a welfare society, born as a reaction against the social discrimination of the poor law may … widen rather than narrow class relationships’. So Titmuss moved on to an examination of the nature of ‘needs’. All ‘collectively provided services’ were a deliberate attempt to meet socially recognised ‘needs’. As such, they embodied ‘society’s will to survive as an organic whole’, and the population’s ‘expressed wish … to assist the survival of some people’.‘Needs’ were both social and individual, with no ‘complete division between the two’ conceptually possible. Moreover,‘needs’ changed over time, over the life cycle, and with changing social definitions. Again, how this was recognised, and addressed, rested on the extent to which ‘needs’ should be met in the ‘interests of the individual and/​or society’. For instance, British society in the 1950s was very different from that of the beginning of the century. Illustrating how perceptions of ‘needs’ might have changed, Titmuss cited Freud as ‘undermining our psychological innocence’, while Marx was credited with ‘opening our eyes to economic realities’. Over the first half of the twentieth century,‘the era of rising expectations’, there had emerged ‘those forms of state intervention which, by custom and common approval, have come to be called “the social services” ’.This had started with the ‘welfare revolution’ of the pre-​1914 Liberal governments, with the most recent manifestation being the ‘Beveridge “insurance revolution” and its aftermath’.The term ‘social service’ had, moreover,‘acquired a most elastic quality’, moving beyond simply poor relief.20 Coming towards the heart of his argument, Titmuss then pointed out the anomalies in official classification as to what constituted a ‘social service’, and warned against the consequent dangers inherent in assuming a ‘self-​contained social service system expressly designed for the transmission of benefits from one income group … to another’. For example, family allowances were classified as a social service, whereas

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tax allowances for children were not, notwithstanding that, in principle, both were forms of state intervention pursuing similar ends. To put it another way, some forms of state intervention were deemed ‘social’ while others were not.There were thus three types of welfare –​social, fiscal, and occupational –​and broadly speaking these were organisational divisions which reflected ‘the division of labour in complex, individuated societies’. Social welfare dealt primarily with ‘states of dependency’, including those which were ‘natural’, for example old age, and those shaped by social and cultural factors, such as unemployment. The latter had grown in scope and scale in the course of the preceding century, leading to one of the ‘outstanding social characteristics of the twentieth century; the fact that more and more people consciously experience at one or more stages in their lives the process of selection and rejection’. Again, much of this was attributable to the greater and greater division of labour and its corollary, increasingly specialised work tasks.Titmuss alluded to, although he did not expand upon, the psychological implications of this ‘threatening’ development which, as he was to go on to argue, also influenced his two other categories of welfare.21 Turning to fiscal welfare, this was defined as tax allowances, and forms of tax relief, which, ‘though providing similar benefits and expressing a similar social purpose in the recognition of dependent needs’, were not, however,‘treated as social service expenditure’. Rather, benefits accruing from fiscal policy were dealt with as an ‘accounting convenience’, rather than as a ‘cash transaction’. Titmuss focused on what was something of an obsession, support for university students. Under the then prevailing tax regime, allowances for children were awarded not only when offspring were in need of direct support. They also embraced young people receiving full-​time tertiary education, on the grounds that they were deferring immediate earnings in favour of acquiring skills which would allow for a future higher level of employment. ‘Social policy’ had ‘thus been extended beyond the confines of support for childhood dependency to the support of individual “self-​improvement” ’.These tax breaks were, moreover, given irrespective of any scholarships or other awards the student may have gained. Underlying all the ‘growth in fiscal welfare policies’ which had developed over the first half of the twentieth century was a ‘continuous search for a reasonable “subsistence minimum” for income tax payers’. The cost of tax breaks primarily aimed at dependants was, by the mid-​ 1950s, over £400 million, compared with just under £800 million for all direct cash payments from national insurance, national assistance, family allowances, and benefits related to industrial injuries and non-​ contributory pensions.22

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Finally, there was occupational welfare. Like social and fiscal welfare, this had expanded considerably over the past half century. Benefits might be in cash, or in kind, with the ‘ultimate cost’ falling ‘in large measure on the Exchequer’. Again, the areas covered by these ‘multifarious benefits’ could in many cases be seen to be a ‘recognition of dependencies’. As such they were effectively ‘social services’, although not in ‘administrative method’. Occupational pensions, for example, already cost the Treasury, through various forms of tax relief, some £100  million annually, more than the cost of national insurance pensions. Such benefits tended to favour better off taxpayers, and hence effectively functioned as ‘concealed multipliers of occupational success’. Superficially, the creation of occupational benefit schemes could be seen as manifesting a desire by employers to be seen as promoting ‘good human relations’. In reality, though, as they grew and multiplied, they came ‘into conflict with the aims and unity of social policy’.They did so because their ‘whole tendency … is to divide loyalties, to nourish privilege, and to narrow the social conscience as they have already done in the United States, in France and in Western Germany’.23 Summing up, Titmuss argued that the development of the three different forms of welfare showed how ‘narrowly conceived and unbalanced are the criticisms so frequently levelled at the one system traditionally known as “the social services” or, more recently and ambiguously, as “The Welfare State” ’. The latter was only the ‘most visible part of the real world of welfare’, and, by focusing exclusively on it, the ‘social history of our times inevitably becomes, in the process, sadly distorted’. The three categories presently operated ‘as virtually distinct, stratified systems’, with what went on within each ignored by the others. What they had in common was the social recognition that individuals were not wholly responsible for any given state of dependency, and how such dependencies may impact on families. But there were problems.The search for equity between taxpayers, an aspiration of fiscal welfare, for instance, was not necessarily compatible with a search for equity between citizens. The problems of achieving ‘equity in social policy’, though, had become more complex because of factors such as the ‘accumulation of long-​lived “disservices” ’, that is, individual and social disadvantages which had built up over time in the wake of industrialisation, and greater social differentiation. In turn, there was a real possibility of increasing social inequality, and both individual interests, and those of society as a whole, were being pushed aside by group or class interests. So, once more, the search for equity was constrained by sectional aims which invariably benefited the ‘most favoured in proportion to the distribution of power and

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occupational success’. Individuals, meanwhile, gained a heightened awareness of their dependency, and the possibility of failure, and so were ‘more exposed to pain’. Within the ‘theoretical’ framework he had put forward, it thus became possible to analyse the development of his three systems of welfare ‘as separate and distinctive attempts to counter and to compensate for the growth of dependency in modern society’. But as presently organised they were ‘simultaneously enlarging and consolidating the area of social inequality’.This, then, was the ‘real challenge to social policy and to those who, mistakenly, still look to the past for a solution’.24

Addressing social workers In August 1956 Titmuss addressed the International Conference of Social Work, held in Munich, on ‘Industrialization and the Family’.The clumsily entitled theme of the session to which Titmuss contributed was ‘The Role of Social Work in Helping Families Affected by the Trend towards Industrialization’, and he was the first plenary lecturer. Among his fellow speakers was US Social Security Commissioner Charles Schottland, soon to be an important figure in Titmuss’s engagement with America.25 The timing and audience of the Munich event was significant, for Titmuss was at this point in the throes of the dispute in his own department over the future of social work training. As with many of his speeches, this one was complex and full of detail and nuance, and only the bare bones are given here, although again enough to unpick his current preoccupations. Titmuss began by suggesting that his subject matter might appear a little unusual for a social work conference, being apparently ‘abstract and unattractive, perhaps a little off the well-​trodden professional path of casework’. But there were three reasons why industrialisation and the family was ‘an important subject for debate by an international conference of social workers’. First, it offered the opportunity for comparative analysis. Second, the world was becoming ever more an ‘industrial world … dominated in its values and goals by problems of economic growth’. So industrialisation was to be welcomed as a means of bringing benefits to the whole of humanity, not just the West. However not all societies were experiencing the same benefits, so inequalities between nations ‘are now being considered in much the same way as inequalities within nations and between social groups’. Nonetheless, there was a widespread desire for change, ‘the motive force for which lies in the idea of progress –​material progress –​the idea that ruled the life of Britain in the nineteenth century’. Third, in

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a more industrialised world, more social workers would be needed, along with the expanded ‘social resources’ necessary for the profession to ‘effectively fulfil its ethical responsibilities’.26 After these introductory comments,Titmuss then focused in on the industrialised West’s experience. He paid particular attention to the rate of industrial change and, second and related, to the various effects, short and long term, of industrialisation. Both were ‘often neglected in the historical treatment of industrial and technological change’. On the rate of change, for example, the ‘knowledge slowly won by the behavioral sciences’ now demonstrated the limits, particularly with respect to families and children, to the ‘speed at which social change can take place without causing grave psychological problems’.This was but one example of how change was multifaceted, with each factor contributing to economic growth ‘also a factor contributing to social need’. So the countries of the West long industrialised were ‘still heavily burdened by the as yet uncompensated disservices of the earlier stages of their economic growth’. A more obviously contemporary concern was the impact of the ‘second industrial revolution’, which, by way of changes such as mechanisation and automation, had led to a rise in working class living standards. But it had also resulted in the ‘degradation of the worker, bereft of personality and of his roles as husband, father, and citizen’, which found ‘conscious expression in the idea of “scientific management” ’. It was, as yet, not fully understood what impact this had had on the family. Nonetheless, Titmuss offered some insights of his own. The loss of status resulting from the ‘second industrial revolution’, for instance, could lead to a ‘serious injury to the personality’. The sort of changes involved in mechanisation and automation, and by association ‘scientific management’, could ‘all signify submission, dependence, loss of initiative’ on the manual worker’s part.27 Titmuss was talking primarily about male workers here, and suggested that their reactions to loss of status could play out in various ways. One response on the part of employers, which he rejected, was the attempt to improve factory relations by the ‘provision of miniature occupational welfare states’, for these involved ‘less freedom of choice and, consequently, less rather than more control by the worker over his own affairs’. More than this, such provision could involve ‘more social and psychological pressures toward submissive and conforming behavior in the work place’, which in turn could have ‘disturbing effects in the home when the worker, released from the determinism of the factory, attempts to recover possession of himself ’.As to the family, the problems it faced could not be resolved simply within itself, for the ‘family does not function in a social vacuum’. As an institution the family had been

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forced on the defensive, being placed in ‘more situations of divided loyalties and conflicting values’. It had been ‘forced to choose between kinship and economic progress; and it has been constantly subjected to the gales of creative instability’. In such circumstances the social services thus had to operate in a ‘variety of stabilizing, preventive, and protective roles’. More broadly and fundamentally, ‘one of the major tasks of the second half of the twentieth century’ was to ‘reformulate the philosophy of social policy, and to rescue it from its present inhibitions derived from a “welfare state” ideology’.28

Discussion These were four very rich speeches, and here we can only suggest some of the main themes they embraced, themes which were clearly important to Titmuss, and were to be expanded upon over the rest of his career. A useful starting place is his claim that important areas of modern experience had been neglected by historians and sociologists, and how he attempted, in these talks, to address this problem. In the Fawcett Lecture, for example, he pointed to the lack of knowledge of the lives of working class women, and especially mothers, notwithstanding historical interest in the leaders of the Suffrage Movement. In ‘The Social Division of Welfare’, meanwhile,Titmuss, again with his historian’s hat on, noted the huge differences between contemporary society and that of the Edwardian era, the latter’s ‘welfare revolution’ notwithstanding.Titmuss, who as we know almost always grounded his own writings in the appropriate historical context, can again be seen as an innovator in social history, a field not fully developed in Britain until the 1970s. But he was also at pains to argue that while understanding historical development was important, it was wrong to look to the past for ready-​made solutions to the problems of a much changed society. The nineteenth century Poor Law’s ‘social discrimination’, for instance, had no place in mid-​twentieth century welfare provision. So society was in a permanent state of change, and that change, and its implications, had to be understood. The notion of ‘disservices’, for example, acknowledged that while economic growth, and the onset of modernity, had brought benefits, they had also been responsible for social, and individual, damage. The psychological impact of industrialisation and automation was a case in point. Automation was widely discussed in the 1950s and 1960s, with optimists promising a ‘second industrial revolution’, but trades unionists concerned about loss of jobs.29 For Titmuss there was more to it, involving individual stress, and the unsettling of family life. Closely associated with changes in the

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work process was ‘scientific management’, which sought to control that process, again with potentially damaging psychological consequences for workers.Taken together, all this led to, as Titmuss put it in Munich, ‘serious injury to the personality’. Understanding, and acting upon, the stress and pain engendered by modernity should thus an important dimension of welfare policy. Titmuss’s concern with the impact of automation is particularly notable in the context of his belief in the need to safeguard individual freedom, his longstanding critique of ‘The Acquisitive Society’, and, shortly after the four speeches discussed here, ‘The Affluent Society’. In the light of all this, ways of addressing social problems had to change.As Titmuss told his Edinburgh audience, while what Beveridge had proposed was an appropriate ‘map’ for the 1930s, it was now outdated. New guides were needed to navigate the as yet uncharted waters of post-​war Britain, while the social services should be seen as ‘means’ to a better society, and not ends in themselves. Understanding a rapidly changing society meant, too, a thorough examination of what constituted ‘welfare’. Tax breaks and occupational pensions for the middle classes had expanded hugely in the preceding decades, while remaining analytically neglected. Public social services, on the other hand, were subject to constant scrutiny and attack, and portrayed as a burden on those same middle classes. More than this, schemes such as occupational pensions were socially divisive, leading to, as he told his Birmingham audience, a narrowing of the ‘social conscience’. While both major British political parties subscribed to the view that welfare reform was more or less complete, this was far from the true picture. More could clearly be said.Titmuss’s approach to gender, for instance, is notable. He is sometimes portrayed as a social scientist, and indeed person, blind to the meaning of gender, and essentially patriarchal.There is clearly an element of truth in this. It might be argued, though, that for a man of the early 1950s he showed, in addresses such as ‘The Position of Women’, a sympathetic understanding of the socioeconomic issues facing women in the post-​war era. And as Hilary Rose convincingly argues, whatever Titmuss’s own shortcomings, his insights raised the possibility of analyses of social welfare which took account of gender issues.30 In terms of a ‘philosophy of welfare’, the need to see the social services as integral to modern society, a point made in Edinburgh, and for that society operate, ideally, as an ‘organic whole’, a point made in Birmingham, points again to Titmuss’s holistic approach. So social science should have the aim of revealing the strengths of the post-​war settlement while being unflinching in its criticisms of its shortcomings. Achieving a socially cohesive and integrated society characterised by,

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for example, much reduced inequalities could only be realised by welfare policies which not only recognised society’s constantly changing nature, but were also supported by a moral vision which acknowledged the need for individual freedom and creativity, and for social mutuality. More broadly, we might recall that, in his inaugural lecture at the LSE, Titmuss had argued for the recasting of Social Administration in terms of its scope and philosophical underpinnings. The four lectures discussed in this chapter were, taken together, an important contribution to such a recasting.

Conclusion In 1956 Anthony Crosland, a leading Labour Party figure, brought out his famous work, The Future of Socialism. Crosland took Titmuss’s inaugural lecture mildly to task for failing to appreciate the extent to which taxation, and the social services, were already distributing ‘income in the right direction’. He thus suggested the need for a ‘Reaction against the Fabian Tradition’. Invoking the Webbs, but probably with Titmuss and his colleagues also in mind, Crosland acknowledged that ‘We have all, so to speak, been trained at the LSE’. But while those on the left acknowledged that ‘hard work and research are virtues’, a ‘reaction’ was nonetheless required. This should take the form of, especially, a greater emphasis on ‘private life, on freedom and dissent, on culture, beauty, leisure, and even frivolity’. In a much quoted passage, Crosland declared that ‘Total abstinence and a good filing-​system are not now the right sign-​posts to the socialist Utopia: or at least, if they are, some of us will fall by the wayside’.31 Crosland’s book was a foundational text of Labour Party ‘revisionism’. Among its central components was that economic growth was a given, and beneficent, and that society should now focus on improving the social and cultural environment. In industry, automation should be seen as producing more wealth, rather than as degrading skills, or a threat to jobs. Indeed, Crosland’s book can be seen as a challenge to the ‘puritanical’ approach of those such as Titmuss. Clearly the picture of contemporary British society which Titmuss painted in the four addresses discussed, as well as in his inaugural address, was rather different from that of the optimistic Crosland. Titmuss’s scepticism persisted for the rest of his career. But, as we know, he was not simply concerned with ideas in the abstract. For him, his academic endeavours should have implications for, and applications in, policy discussion and formation.The next two chapters show how this played out with regard to healthcare and to pensions.

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Notes 1 LSE/​Staff File/​Titmuss, letter, 12 May 1955, RMT to Carr-​Saunders. 2 TITMUSS/​7 /​6 0, flyer, ‘London County Council Public Health Department: Course of Lectures for Health Visitors, School Nursing Sisters and Tuberculosis Visitors. The Family in a Changing Society’. 3 A. Oakley, A Critical Woman: Barbara Wootton, Social Science and Public Policy in the Twentieth Century, London, Bloomsbury, 2011, pp 189–​96. 4 R.M. Titmuss, ‘The Position of Women: Some Vital Statistics’, in Essays on ‘The Welfare State’,, pp 88, 89.The published version had been slightly updated, but the gist of the original lecture remained intact.There had, in fact, been more research into working class women’s lives than was here acknowledged: see A. Oakley, ‘Women, the Early Development of Sociological Research Methods in Britain and the London School of Economics: A (Partially) Retrieved History’, Sociology, posted online 4th September 2019. 5 S. Szreter and K. Fisher, Sex before the Sexual Revolution: Intimate Life in England, 1918–​1963, Cambridge, Cambridge University Press, 2010, pp 70–​71. 6 Titmuss, ‘The Position of Women’, pp 89–​90, 92–​3, 94, 98. 7 Ibid, pp 101, 102, 103. 8 H. McCarthy, ‘Social Science and Married Women’s Employment in Post-​War Britain’, Past and Present, 233, 1, 2016, p 277. 9 R.M.Titmuss,‘Foreword’, in P. Jephcott, N. Seear, and J.H. Smith, Married Women Working, London, George Allen and Unwin, 1962. 10 McCarthy, ‘Social Science’, pp 277–​8 and passim. 11 J. Harris, ‘Political Thought and the Welfare State 1870–​1940: An Intellectual Framework for British Social Policy’, Past and Present, 135, 1, 1992, pp 125, 133, 137. 12 J. Offer, An Intellectual History of British Social Policy: Idealism versus Non-​Idealism, Bristol, Policy Press, 2006, Ch 6. 13 D. Donnison,‘Supplementary Benefits: Dilemmas and Priorities’, Journal of Social Policy, 5, 4, 1976, pp 337–​8. 14 TITMUSS/​3/​370, undated (but 1955) typescript, RMT, ‘The Social Services’, pp 2, 4. 15 Ibid, pp 14–​15, 16–​17. 16 P. Addison, No Turning Back: The Peacetime Revolutions of Post-​War Britain, Oxford, Oxford University Press, 2010, p 185. 17 R.M. Titmuss, The Social Division of Welfare: Eleanor Rathbone Memorial Lecture, Liverpool, Liverpool University Press, 1956, p 2. 18 TITMUSS/​7/​63, letter, 7 November 1955, RMT to Burns, New York School of Social Work, Columbia University. 19 Titmuss, The Social Division of Welfare, pp 3, 4–​5. 20 Ibid, pp 6–​7, 8–​9. 21 Ibid, pp 10, 11, 12. 22 Ibid, pp 13–​14, 15–​16, 17–​18. 23 Ibid, pp 19, 20, 21. 24 Ibid, pp 21, 22, 23. 25 ‘International Conference of Social Work: Eighth Session’, Social Security Bulletin, November 1956, pp 11–​15. 26 R.M. Titmuss, ‘Industrialization and the Family’, Social Service Review, 31, 1, 1957, p 54.

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12 The Guillebaud Committee and the early years of the National Health Service Introduction Even before arriving at the LSE, a significant proportion of Titmuss’s work was concerned with health. He had researched population health, was interested in eugenics, and had contributed to the origins of social medicine. Much of what he argued was shaped by the idea that ill health might have socioeconomic, or even psychological, causes. Consequently, treatment or, preferably, prevention should involve dealing with the individual’s environment as much as their body. In terms of how this might be realised, Problems of Social Policy had drawn attention to the supposed shortcomings of existing provision, and called for large-​ scale social reconstruction once the war was over. To some extent this materialised perhaps most successfully in the shape of the NHS, whose creation, as we noted in Chapter 1, Titmuss was later to describe as ‘one of the most unsordid and civilised actions in the history of health and welfare policy’. This chapter examines Titmuss’s analysis of health and healthcare in the first decade or so of the new service. Although an enthusiastic supporter of the NHS, and proponent of the idea that it constituted good value for money, Titmuss was not unaware of its shortcomings. It is important to recognise, too, that the post-​war era saw not only organisational changes in healthcare. Startling advances in drug therapies and surgical techniques seemed to further advance the phenomenon of ‘scientific medicine’. Reviewing a clutch of books on social medicine in 1954, Titmuss noted that the ‘new accent’ on the social content of medical theory and practice was, in part, a response

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to ‘the scientific revolution’ which had been sweeping through medicine since the discovery, in 1935, of sulphonamides, the first class of drugs to effectively tackle certain pathogenic bacteria. Medicine had to respond to this ‘revolution’ in ‘not one but in a hundred and one ways’.1 Scientific advance was not, in other words, unproblematic, a theme which informed Titmuss’s interventions on healthcare.

Thinking about the NHS In 1949 Titmuss joined a research body with its origins in Political and Economic Planning, chaired by François Lafitte, the Joint Group on Active Democracy and Health. Other members included friends and colleagues of Titmuss’s, such as Ruth Glass (wife of David, and an important social scientist in her own right), the socialist doctor Horace Joules, Albertine Winner from the Ministry of Health, and Michael Young, author of the Labour Party’s election manifesto in 1945 and soon to be Titmuss’s PhD student.Among the issues the group addressed were hospitals as social institutions, and how they were to be managed. As Lise Butler puts it, such research questions ‘reflected increasing concern within the medical, sociological and political community that the patient’s emotional experience of care greatly affected the success of his or her treatment’. For the group, the hospital was not simply ‘a factory for the repair of human bodies’. It was also a social institution through which citizens came to experience, and form judgements upon, the state.2 All this was very much in line with Titmuss’s own approach to healthcare. He was concerned, for instance, that patients, as with others reliant on the social services, be treated with dignity and respect, and that doctors be sensitive to patients’ psychological and social needs. Picking up on such points, in May 1952 Titmuss addressed the Institute of Hospital Administrators, an organisation set up in 1942 but with its origins in the early part of the century. In his speech, ‘The Hospital and its Patients’, Titmuss began by suggesting that in ‘depth and range of complexity, the hospital as a social institution has few rivals to-​day’, and that this complexity continued to grow. This raised three potential dangers. First, it could lead to ‘increasing economic and social costs with a proportional rise in value rendered to the community’. One implication was that the health services should be subject to external scrutiny, particularly to resist the ‘pressure of many vested interests and forces’. The second possible danger was that the process of running hospitals might come to obscure the actual reason for their existence as social institutions.Titmuss welcomed the increased freedom that socialised medicine had delivered in that, for instance, doctors did

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not now have to concern themselves with patients’ financial resources. Nonetheless, it was all too possible that hospitals might increasingly be run ‘in the interests of those working in and for the hospital rather than in the interests of the patients’.3 In both these points we can, once again, discern Titmuss’s fears about overbearing professional power. Third, advances in medical science and technology had made it ‘harder to treat the patient as a person’. There was, therefore, an issue of ‘the social and psychological welfare of patients in a hospital situation of applied scientific medicine’. Problems might arise because of over-​rigid rules, organisational ‘fetish’, or, on the most human level, lack of social interaction between staff and patients. Why, then, was it not recognised ‘that courtesy and sociability have a therapeutic value?’ In part, such blind spots could be attributed to ‘some failure in education and professional training’ in which the ‘sociology of the patient’ was currently neglected. Overall, the ‘quality of medical care’ was one of the ‘crucial problems of social medicine in the twentieth century’, something increased by the arrival of the NHS, the growth of scientific medicine, and administrative complexity. All of these might lead to ‘losing sight of the individual patient’. Following contributions from the floor, Titmuss responded that one of those who had spoken had raised ‘one of the most important problems’ facing the Institute and its members, namely ‘how far their responsibility and powers lay in correcting and adjusting’ certain characteristics of the hospital system ‘in relation to the powers and responsibilities of the medical and other professional groups’. He had been encouraged that many in the audience were ‘aware and conscious of these problems’.‘Humanitarianism’ was clearly ‘very much in the minds of the administrators’. What he sought, in common with many of those present, was ‘to be in a position to stimulate self-​examination and self-​criticism within the hospital, amongst all groups working there’.4 Especially notable here is Titmuss’s concern that individual patients might get lost in a technocratic and bureaucratic system. We get a further sense of Titmuss’s preoccupations in a letter to The Times just over a year before his Hospital Administrators’ speech, and a few months before the demise of Clement Attlee’s second Labour administration in October 1951.Titmuss claimed that no ‘reasoned explanation has yet been given by the Government for the decision to transfer a large range of functions from the Ministry of Health to the new Ministry of Local Government and Planning’. This apparently arcane issue came at a time when the Labour government was split over the introduction of health service charges, resulting in the resignation of the former Minister of Health, Aneurin Bevan, in the latter stages of this dispute relocated to the

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Ministry of Labour. Charles Webster argues that Bevan’s resignation gave Attlee the opportunity to revisit ‘his long-​awaited scheme to dismember the Ministry of Health’. The issue here was that the Ministry dealt not only with the NHS, but also with local authorities. The separating out of these services was to have the consequence, intended or otherwise, of reducing its status.Titmuss objected strongly to the divorce of health and local authority provision, questioning, for example, whether this would lead to a ‘complete separation at the centre between, on the one hand, the hospital and medical services and, on the other, the social and environmental services’. He agreed that in the ‘modern State’ there had to be ‘some awkward and unpopular functional divisions’. But these should not occur in ‘services which involve personal relationships with people’. For instance, it would appear that ‘the health visitor will come under one Ministry and her colleague, the sanitary inspector, under another’. To so rearrange functions, and on this scale, could only ‘bring about a state of chaos in the administrative and executive departments concerned’. Hinting at the deep-​rooted difference within the government,Titmuss suggested, too, that the ‘chaos that at present reigns in the Ministry of Health will not … be resolved for a long time to come’.5 It is intriguing to speculate whether Titmuss’s letter can be seen as implicitly supporting Bevan in his unavailing struggle. Titmuss also consistently emphasised the need to see health in its broader social context, and to argue for close coordination between all social services. In this particular case, if environmental factors could impact on individual health, then surely the ideal was that they were dealt with by one part of the ‘welfare state’.We again see Titmuss’s stress on patients’ needs. More broadly, he was acutely conscious that the NHS was the object of political debate, especially regarding costs. With the return of a Conservative government in 1951, this took on a new urgency. As Pat Thane observes, the Conservatives had gone to the country with a programme arguing for social service cuts. It was notable, for instance, that their election manifesto referred not to the ‘National Health Service’, but simply to the ‘Health Service’.6 None of this was lost onTitmuss. In 1953 he reviewed one of the first histories of the NHS, James Stirling Ross’s The National Health Service in Britain. This was ‘a clear, methodical account’, although he also had reservations. For present purposes, though, what is important is Titmuss’s claim that in a number of areas the service was ‘set on a course of contraction’, and that it was difficult to see where this would lead. Part of the problem with Ross’s book was that it assumed that there was a ‘right’ amount of money to be spent on healthcare, and that to define this it was necessary to make NHS funding a non-​contentious matter, through reconciling health policy and

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finance. Titmuss, clearly not impressed, noted further that this had been ‘said before and on many occasions by the leaders of the British Medical Association’. His closing comment, picking up one of his core ideas, was that ‘It all begins to get a little unreal when society is left out’.7 Around the same time, Titmuss was contacted by the BBC about ‘an important evening programme with a serious intention’ to mark the NHS’s fifth anniversary. Even allowing for flattery, his correspondent’s next remarks are revealing, for she suggested that ‘the difference between mediocrity and brilliance will be the difference between your absence or presence on the evening in question’.8 The programme, hosted by the well-​known broadcaster Dudley Perkins and entitled ‘Can We Achieve Health?’, was broadcast on 9 July 1953, and also included Jerry Morris. Among the topics raised by Titmuss was that economists and the chairmen of banks, along with much public opinion, took ‘a purely economic view of the social services’. Consequently, they recommended ‘drastic cuts’, with the majority arguing that the NHS, and especially the hospital service, should bear the brunt. For Titmuss, part of the problem was a lack of up-​to-​date thinking, exemplified by the widespread belief that the ‘social services are … concessions given by or extracted from one class in society for the benefit of another class’. But these were ‘nineteenth century values’ –​one of his bugbears. He also pointed to confusion about what did, and did not, constitute a social service. State pensions, for instance, were counted as such, while ‘non-​contributory pensions and schemes administered by private insurance companies’ were not. Economic efficiency, moreover, had to be considered alongside issues of ‘morality’. Widespread social changes were as ‘relevant to the performance of the economic system’ as they were to ‘the performance of the National Health Service and other social services’. To see the matter from this standpoint ‘annihilates the view of the Health Service as a beneficent appendix to the economic order; it annihilates the stereotype of the “Welfare State” which is steadily acquiring the characteristics of a national illusion’.9 Here was an early instance of Titmuss’s famous ‘Social Division of Welfare’, along with his usual emphasis on morality, and his identification of the standard view of the ‘welfare state’ as a ‘national illusion’. Not for the last time, economists, and chairmen of banks, came in for criticism. More immediately, though, Titmuss was clearly fearful about potential attacks on the NHS. Was he right to be so, and, if so, what did he do about it?

The Guillebaud Committee In 1952, Iain Macleod and Enoch Powell, rising stars of the now governing Conservative Party, claimed that, in taking part in Commons

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debates on health and social insurance in 1951, it had become ‘increasingly clear that the feature which they had in common –​the application of a means test to social services hitherto without it –​was of more than minor significance’.10 At the heart of this argument was the idea that, ultimately, social services should be residual, and reserved for the neediest in society, those without access to any other resources. As Harriet Jones points out, even before the 1951 election victory Macleod and Powell had been central to the party’s welfare strategy, and were later to be associated with the notion of an ‘Opportunity State’, a neat formulation challenging the notion of a ‘welfare state’.11 Thane likewise sees such moves as the beginning of a ‘long assault on universal services …, guiding Conservative policy for the remainder of the century and beyond’.12 More immediately, in Cabinet the Chancellor of the Exchequer, R.A. Butler, told his colleagues in January 1953 that ‘no Chancellor could view without grave misgivings the prospect that expenditure on the Health Service will go on increasing for years to come’. He was thus suggesting a ‘small independent Committee of four or five members of acknowledged ability and standing’ to look into NHS costs.13 To put this in context, in the course of Titmuss’s LSE career, expenditure on publicly funded health services as a percentage of gross domestic product rose from 3.46 in 1951 to over 4.00 by the time of his death. But growth was not especially strong in the 1950s. For the first decade or so of its existence, relatively meagre funds were devoted to the NHS.14 As we shall presently see, Abel-​Smith and Titmuss were to be among the first to argue for more, rather than less, resources for healthcare on the basis of carefully accumulated evidence. In turn, this suggests the highly politicised nature of debates on welfare expenditure, then as now. In any event, as Webster puts it, the Conservative government of the early 1950s was, like its Labour predecessor, ‘haunted by the spectre of rising costs on the National Health Service’.The Treasury, too, was keen to see restraints on expenditure. Consequently in April 1953 Macleod, now Minister of Health, told the Commons that a committee, chaired by the Cambridge economist Claude Guillebaud, was being set up to investigate the cost of the health service. As Webster further points out, the Committee was, by its very existence, a constraint on Treasury cuts, partly because of the slow pace of its deliberations, but also because it increasingly began to put forward arguments for increased, rather than decreased, spending. Furthermore, it outsourced some of the more technical, social accounting aspects of its work to the National Institute of Social and Economic Research (NIESR). Abel-​Smith was to be the lead investigator, with Titmuss as a consultant and his

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research supervisor. Abel-​Smith’s research was also to form the basis of his Cambridge doctorate, with Guillebaud as one of the examiners. As Webster remarks, although Abel-​Smith and Titmuss’s ‘contact with the Guillebaud Committee was minimal’, a memorandum read by the Committee in January 1955 ‘was fundamental to setting the tone of the Guillebaud Report’. And, moreover, ‘in its separately published form the elegant work of Abel-​Smith and Titmuss overshadowed the pedestrian report, and achieved stature as a minor classic of modern social analysis’.15 This ‘minor classic’ was The Cost of the National Health Service in England and Wales, published in 1956.16 As Abel-​Smith did the bulk of the research, as well described by Sally Sheard, commentary is confined to the more general points which he and Titmuss sought to raise.17 In his foreword, Guillebaud praised the ‘conspicuous thoroughness and skill’ of the authors, noting that, for the first time, ‘the modern technique of social accounting has been applied in an expert manner to one of the major sectors of the social services’.The authors’ findings had, for the most part, been absorbed into the Committee’s report.18 The volume’s introduction, meanwhile, was written by W.A.B. Hopkins, Director of the NIESR. Hopkins recounted how the Guillebaud Committee, shortly after its inception, had approached his organisation to produce a memorandum on NHS costs. Hopkins acknowledged that it might seem ‘strange that information of a kind which would seem essential to any informed public discussion of Health Service expenditures  –​a matter which has not lacked public discussion  –​ should not have been available before’. There was, therefore, a need not only for the data presented, but also ‘for better statistical records of the operation of the Service, and in particular for fuller and more scientifically organized information on the kinds of people who use it and the purposes for which they use it’.19 So what was revealed in the body of the Abel-​Smith and Titmuss volume? It started by noting that possibly ‘no other development in social policy in any country has evoked so much international interest in recent times’ as the NHS, and its economic circumstances. One reason for this had been the ‘common experience of the rising costs of medical care’, in turn partly caused by ‘the scientific and technical changes which have universally invaded medicine during the last decade or so’. It was not their intention to discuss these trends. But in noting them, Abel-​Smith and Titmuss alerted readers to what, as we have seen, was the all-​important context.Among the many points their volume would illustrate was that the ‘Government’s Appropriation Accounts have failed to indicate’ the cost of the NHS ‘in any economically useful way’.20

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Such concerns about official data were, as we have seen, a recurring theme in Titmuss’s social research. More specifically, what conclusions could be reached? First, the cost of the NHS had been rising, although the introduction of charges for items such as dentures had contributed to revenue, while dampening demand. Second, although costs had risen, they had done so as a declining proportion of national income. In other words, the economy was growing faster than NHS expenditure. Third, NHS costs had not only risen less markedly than the retail price index but in some areas, for instance the dental and ophthalmic services, had actually fallen. Fourth, there had been a change in the way resources were allocated within the NHS, although one broader point was that these had not, for the most part, diverted resources from elsewhere in the economy. Finally, even when population change was factored in, there had been relatively minor changes in cost per head over the period studied. All this was a technical way of substantiating the argument that,‘Contrary to public opinion, the net diversion of resources to the National Health Service since 1949/​50 has been of relatively insignificant proportions’. The NHS was, therefore, value for money, and those who criticised it on cost grounds were simply wrong. As to the future, again the paucity of official data made predictions difficult. But the authors were at pains to dispute that, notwithstanding an ageing population, old age was in itself a problem, and the next chapter will further discuss Titmuss’s contemporaneous grappling with this issue.This implied the need to expand other forms of care. Given that the NHS was, by this point, seven years old, and now had a ‘more skilled and technically experienced corps of administrators behind it’, it was time ‘a further step forward in the collection, classification and analysis of facts’ was taken. This would counter the current ‘public alarm about the cost of the National Health Service’.21 In the wake of the Guillebaud Report, Macleod, soon to be moved on from the Ministry of Health, informed the Prime Minister and his Cabinet colleagues that it had ‘very few useful proposals’, that it was ‘almost embarrassingly favourable’ to the NHS and its administration (Macleod took some satisfaction from this, at least), and so that ‘any idea of major economies, whether in the form of so-​called administrative economies, or in the form of cuts in the Service through new charges or other methods, can no longer hold the field’.22 Such was the impact of Abel-​Smith and Titmuss’s findings that no further independent review of NHS expenditure was carried out in their lifetimes.23 They truly had made an impact, and not only in Britain. Titmuss was told by the Ministry of Health’s Chief Medical Officer, J.A. Charles,

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that he had been contacted by his Canadian opposite number about the Guillebaud Report, and the associated Abel-​Smith and Titmuss volume. Both had ‘aroused considerable interest in many quarters’ in Canada.The federal government had made an offer to the provinces of grants-​in-​aid for hospital insurance which, if accepted, would require particular forms of administration, and systems of statistical reporting. A Canadian official from the Health Ministry’s Research and Statistics Division was being sent to Britain, and would like to meet Titmuss and Abel-​Smith. Titmuss agreed to this, suggesting that David Donnison (recently appointed Reader at the LSE) also attend, as he had been in Canada a couple of years previously.24 In due course, the Canadian federal government passed, in 1966, the Medical Care Act. This created a national system of healthcare and built on, especially, the 1956 Hospital Insurance and Diagnostic Act.25 The latter was, presumably, the legislation referred to in Charles’s letter.

After Guillebaud: prescriptions Although Titmuss was a firm advocate of the NHS and its ethos, he recognised that some of the costs imposed raised complex questions. Shortly after his work for Guillebaud, he reviewed some the controversies around the coming of the 1911 National Insurance Act. The act had introduced limited measures of sickness insurance, notwithstanding opposition from the BMA and commercial insurance companies. Titmuss suggested that lessons could be learned for those addressing the problems of the present-​day NHS. Among the issues raised had been ‘the administrative and ethical issues involved in the provision of “free” drugs’, as well as the ‘role of professional associations in relation to State policies for medical care’.26 Around the same time, John Martin undertook a study of the social aspects of drug prescription under the NHS, funded by the LSE and the Nuffield Provincial Hospitals Trust.27 As we have seen, almost from the NHS’s inception both Labour and the Conservatives had been concerned about rising costs, and what Webster calls the ‘deluge of demand’, one reason why prescription charges had been introduced in 1952, and raised in 1956.28 Behind this lay the belief that some GPs were ‘overprescribing’ drugs given that, at least in the first instance, prescriptions involved no cost to either patient or doctor. If this were so, then it could be a significant contributor to the allegedly spiralling NHS expenditure. The issue of prescriptions was to plague subsequent healthcare policy, but, in a sense, is a proxy for wider issues to do with funding and entitlement.Titmuss himself, as Martin made clear, had originally wanted to investigate the

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social factors involved in prescribing, and had given the study’s author ‘invaluable advice and criticism’, as well as providing the foreword.29 It was certainly the case that drug prescription was a longstanding interest for Titmuss. At the introduction of prescription charges in 1952 he noted, in a letter to The Times, findings which appeared to suggest differentials in prescribing, in effect, according to social class, with previously private patients now incurring higher prescription costs. Titmuss then argued that the decision to impose a one shilling prescription charge could encourage, rather than discourage, excessive prescribing. Moreover, if there was already ‘a tendency to abuse, by doctor or patient or both, then the [proposed] method of applying the charge may be viewed, by anyone familiar with the psychology of the doctor–​patient relationship in which prescribing takes place, as the one method best calculated to encourage such a tendency’. He then pointed to the lack of published information on differential prescribing.30 Much of Titmuss’s argument was abstruse, and technical. Nor was it expressed with notable clarity. But it does illustrate his interest in the dynamics of the doctor/​patient relationship, and the notion that the middle class would do better out of services such as the NHS because of their relationship with their doctor, and their cultural confidence. In his contribution to Martin’s volume, Titmuss described two key factors in rising costs of drug prescription. The first was the ‘objective fact of the scientific revolution in medicine’ which had resulted in ‘an immense increase in the number, variety and cost of pharmaceutical preparations available to the doctor’. What Titmuss was again driving at here was the astonishing post-​war development, which had nothing to do with the NHS as such, of drugs such as antibiotics which could be used to alleviate both chronic and life-​threatening conditions. The second factor was ‘the growth in public recognition of the potential value of these products of scientific medicine’, a phenomenon less measurable than the first.This was a rather coy way of acknowledging Webster’s ‘deluge of demand’, in part fuelled by rising expectations about drugs, and the popular feeling that everything was ‘free’ under the NHS.There was a need to define more precisely what might constitute ‘excessive’ prescribing. Ultimately, the issue resolved itself into the more general question of what society, and the medical profession, regarded ‘as “good” doctoring’. The present study sought to examine what lay behind ‘prescribing behaviour and the consumption of medical drugs’. As such, it was an ‘essay in the craft of social research applied to a particular problem of social policy’. As the author showed, the problem had been ‘growing in importance’ since the 1911 Act ‘brought to the public surface the question of how and in what form the control of

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prescribing should be exercised’. Martin’s study was essentially statistical, and thus limited. It should not, though, be thought of as an ‘alternative to more intensive investigation of the psychological and sociological factors which contribute to … prescribing behaviour’. Both had part to play ‘in the advancement of knowledge’. Indeed, Martin had done as much as could be achieved with current data, and in so doing had ‘singled out and shown the important part played in national and local patterns of prescribing of social class, ill-​health and custom’. Consequently, many of the ‘generalizations about this social phenomenon of prescribing’, which had flourished since the coming of the NHS, would now have to be revised’.31 This was a particular version of the more general point, made by Abel-​Smith and Titmuss, about the need for more social research into the healthcare system. What is notable is that Titmuss did not make a systematic case for, or against, prescription charges.

After Guillebaud:  Members One of Another Abel-​Smith and Titmuss were to be afforded an opportunity to bring their insights directly into the political arena. In the wake of their work for Guillebaud, they were invited to join the Working Party on the National Health Service set up by the Labour Party in autumn 1958, one of a number of such initiatives undertaken in the run-​up to the 1959 general election. Other members included, at various points, Crossman, Bevan, and the Socialist Medical Association’s David Stark Murray. Ultimately, this resulted in the policy document, published in late summer 1959, Members One of Another.The pamphlet’s title comes from the New Testament, an illustration, perhaps, of Harold Wilson’s famous quip that the Labour Party owed more to Methodism than to Marx.While Abel-​Smith was an assiduous attendee of the Working Party, Titmuss, because of a bout of tuberculosis which impacted on most aspects of his work in the late 1950s, was not (indeed, the invitation to join the Working Party had included best wishes for a speedy recovery).32 Around the same time,Titmuss told a Canadian colleague that he had now had ‘three months inside experience’ of the NHS. The care provided had been impressive, and he was now on a regime of ‘many drugs and much somnolence’. This treatment had ‘saved us from financial catastrophe’, an indicator of the seriousness of Titmuss’s condition, and his apparent fear that he might have to give up work.33 Tuberculosis had been diagnosed in August, having been misdiagnosed as pneumonia the previous month.Titmuss was given leave to work at

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home, on full salary, with only restricted visits to the School, and no administrative responsibilities.34 Ill health notwithstanding,Titmuss provided the Working Party with a detailed series of discussion points. Overall, these suggested that while at present ‘no dramatic or radical changes can be envisaged’, nonetheless there were ‘probably a hundred and one minor to major changes which in the end represent a radical re-​shaping of the Health Service’. One of the most important issues to be addressed was the need for ‘more trained staff in non-​medical sectors of hospitals, public health, and local authority health services’. Current proposals for changes in mental health provision, for instance, ‘will probably not work because of lack of trained staff ’.Titmuss also claimed that he could ‘make a very strong case for a Royal Commission on the University of London with particular reference to the reform of medical education and training’.35 The Working Party adopted Titmuss’s suggestions. Its Summary of Recommendations included a commitment that a future Labour government would pay ‘particular attention to the training and recruitment of staff in the fields of health and welfare administration’ by way of, for example, the provision of local training courses. It was agreed, too, that a ‘Royal Commission should be set up to investigate the teaching of medicine in the University of London’.36 The pamphlet itself reiterated many of these, and Titmuss’s, earlier points arguing, for instance, that in hospitals nurses and other health workers were ‘just as important as doctors’, and that doctors needed better training ‘in the social aspects of disease, and in psychiatry, industrial medicine, modern prescribing and the special skills needed in general practice’. As things presently stood, teaching at London University, where the bulk of medical education took place, ‘was dominated by Harley Street consultant practice’, and hence ‘isolated from the realities of medical work as most doctors have to practise it’. And when Labour was returned to power, the ‘social services for the community care of those with mental and nervous disorders will be greatly extended, through the local authorities’.37 Peggy Herbison, the Working Party’s chair, subsequently wrote to Titmuss thanking him for his input. It had been ‘a great pleasure to work with you, and I hope you will feel the policy statement justifies your effort’.38 Although not the only person holding such views, the closeness of Titmuss’s submission to the Working Party and the latter’s final product is striking. The work of Titmuss and his colleagues was acknowledged at Labour Party conference and, as we shall see in the next chapter, similar thanks were given at the same meeting for their work on pensions policy.39 And, as Chapter  17 will show, Labour’s

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return to government in 1964 resulted in the setting up of the Royal Commission on Medical Education, of which Titmuss was a member.

Parallels in education In light of Titmuss’s views about criticisms of the NHS, and the need to understand properly the actual nature of health expenditure, his foreword to a volume by John Vaizey on educational expenditure is revealing. This was published a few years after Titmuss’s engagement with Guillebaud, and around the time he was contributing to the Working Party. Vaizey was, at this point, lecturer in economics and economic history at the University of Oxford. His research had been funded, by way of a grant of £500, by the non-​government body the Economic Research Council (ERC). Titmuss acknowledged, in particular, the support of Lady Rhys Williams, ‘who first suggested assistance for Mr Vaizey in the interests of public enlightenment’. Titmuss noted, too, the ‘tiresome and often embarrassing business obtaining funds to promote social research’, all the more reason to thank the ERC.40 As we saw in Chapter 7, Rhys Williams and Titmuss had known each other since at least the Second World War, and this may have helped Vaizey’s application. What else did Titmuss have to say? One reason the ERC had provided support was the need for a ‘more realistic, social accounting approach to the analysis of the costs of education’. But going back to the historical roots of a contemporary policy issue,Titmuss argued that, since its origins in the early nineteenth century, ‘English education policy has not been characterized by any distinctive, positive philosophy’. If such a philosophy was to be brought about, ‘then there must be priorities’, and ‘priorities cannot be shaped without adequate facts’. It was the latter Vaizey had provided. For the first time, these gave the ‘hard facts about the trend in educational expenditures … since 1920’, and, more valuable still, the data had been classified on ‘national accounting principles’. Such data would help society to ‘better identify the problems of educational priorities’. For those who thought that educational provision was ‘one of the most costly elements in a costly “Welfare State”, Mr Vaizey has a clear answer’, namely that a lower proportion of national income was being spent on education than in the 1930s. Vaizey had shown, moreover, that the idea that it was the poorer classes who had benefited from educational reform in the 1940s was erroneous. On the contrary, it was the middle and upper income groups who had gained most, for instance through what were, effectively, subsidies to those receiving private and university education. Titmuss had, furthermore,

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earlier noted the ‘extent to which the education service is … criticized in its social role for being excessively costly and a burden on industry’. In consequence of Vaizey’s findings, though, there could now be ‘little excuse … for inept generalizations about the burden of education’.And, returning to one of his favourite themes,Titmuss concluded by noting the paucity of Ministry of Education data on educational expenditure. Although this was not something upon which he elaborated in any detail, the whole piece was underpinned by a concern about what education should be for –​certainly not, simply, the ‘needs of industry’.41 Here we see Titmuss stressing virtually identical issues concerning state education as he and Abel-​Smith had employed with regard to healthcare. Proper financial analysis must be carried out using ‘national accounting principles’, something which Vaizey had provided, notwithstanding the poor quality of official data. Education needed an underlying ‘philosophy’, based on ‘adequate facts’, if it was to set the necessary social priorities. Education was, like healthcare, a vital social service, but society was now spending less on it than before the war, so in this respect lagged behind even the limited resources allocated to the NHS. This had not stopped criticism of educational expenditure on the grounds that it was a ‘burden on industry’, again just like healthcare. Nor was it the case that the poorest in society had benefited from this component of the ‘welfare state’. To the contrary, the middle classes were not only more successful consumers of healthcare, they were also benefiting from the free education the state sector now provided, or the sort of state subsidies which Titmuss had identified in, most famously, The Social Division of Welfare.

Conclusion Titmuss was undoubtedly a staunch supporter of the NHS, which came closest to the sort of social services he advocated –​universal, without economic barriers to access, and the embodiment of the social solidarity which, by his account, had characterised British society during the Second World War. For those of a like mind, he and Abel-​Smith performed a valuable function in showing so conclusively that not only was the NHS value for money, but also that further investment would be highly beneficial.The service was by no means perfect however. In his work for the Labour Party, Titmuss flagged up a number of concerns, for example medical education, which he would pursue into the 1960s. And in his rather ambiguous attitude to prescription charges, he nonetheless identified, as he had from the early days of the ‘welfare state’, the need for social priorities, alongside the question of

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who actually benefited from welfare provision. In the next chapter we examine his approach to another challenging area of social policy, pensions for old people. Notes 1 R.M.Titmuss reviewing books by J.M. Mackintosh, S. Leff, and A. Leslie Banks, British Journal of Sociology, 5, 1, 1954, pp 87–​8. 2 L. Butler, ‘Michael Young, Social Science, and the British Left, 1945–​63’, DPhil thesis, University of Oxford, 2014, p 79ff and quoting from articles in Planning from 1949 and 1950. I am grateful to Dr Butler for bringing this body of work to my attention. 3 R.M. Titmuss, ‘The Hospital and its Patients’, The Hospital, June 1952, pp 417, 418–​19. 4 Ibid, pp 419–​20, 421–​3, 425. Reprinted in Essays on ‘The Welfare State’. 5 R.M Titmuss, letter, ‘Health Service and Housing:  New Separation of Responsibility’, The Times, 19th February 1951, p 7; C. Webster, The Health Services since the War: Volume 1, Problems of Health Care, London, HMSO, 1988, p 166. 6 P. Thane, Divided Kingdom: A History of Britain, 1900 to the Present, Cambridge, Cambridge University Press, 2018, p 222. 7 R.M. Titmuss, The British Journal of Sociology, 4, 1, 1953, pp 96–​7. 8 TITMUSS/​4/​558, letter, 19 June 1953, Miss I.D. Benzie, Home Talks Department, BBC, to RMT. 9 TITMUSS/​4/​558, Typescript of BBC Home Service Programme, ‘Can We Achieve Health?’, broadcast 9 July 1953, pp 4, 5–​6, 8. 10 I. Macleod and J.E. Powell,‘Preface’, The Social Services: Needs and Means, London, Conservative Political Centre, 1952. 11 H. Jones,‘The Cold War and the Santa Claus Syndrome: Dilemmas in Conservative Social Policy-​Making, 1945–​1957’, in M. Francis and I. Zweiniger-​Bargielowska (eds), The Conservatives and British Society, Cardiff, University of Wales Press, 1996, pp 247, 251. 12 Thane, Divided Kingdom, p 223. 13 TNA, CAB/​129/​58/​30, memorandum, 28 January 1953,‘Proposed Enquiry into the Cost of the National Health Service’, pp 1–​2. 14 J. Stewart, ‘The Political Economy of the British National Health Service, 1945–​ 1975: Opportunities and Constraints?’, Medical History, 52, 4, 2008, pp 453–​70. 15 Webster, The Health Services since the War: Volume I, pp 204–​7. 16 B.Abel-​Smith and R.M.Titmuss, The Cost of the National Health Service in England and Wales, Cambridge, Cambridge University Press, 1956. 17 Sheard, The Passionate Economist, p 83ff. 18 Abel-​Smith and Titmuss, The Cost of the National Health Service, p xv. 19 Ibid, pp xvii–​xviii. 20 Ibid, p 1. 21 Ibid, pp 59, 60–​61, 62, 66, 67, 68ff, 73. 22 Cited in R. Shepherd, Iain Macleod, London, Hutchison, 1994, p 95. 23 C. Webster, The National Health Service:  A Political History, Oxford, Oxford University Press, 2nd Edn 2002, pp 32–​3. 24 TITMUSS/​7/​64, letter, 3 May 1956, Charles to RMT; and letter, 7 May 1956, RMT to Charles.

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RICHARD TITMUSS 25 M.L. Shier and J.R. Graham, ‘Social Policy in Canada’, in Encyclopedia of Social Work, Oxford, Oxford University Press, accessed online 20 December 2017. 26 R.M. Titmuss, ‘A Commentary’, in Sir H.N. Bunbury (ed), Lloyd George’s Ambulance Wagon: Being the Memoirs of William J. Braithwaite, 1911–​1912, London, Methuen, 1957, p 49. 27 J.P. Martin, Social Aspects of Prescribing, London, William Heinemann, 1957, ‘Acknowledgements’. 28 Webster, The National Health Service, pp 29, 37. 29 Martin, Social Aspects, ‘Acknowledgements’. 30 R.M. Titmuss, letter, ‘Prescription Charges’, The Times, 7 April 1952, p 7. 31 R.M. Titmuss, Foreword’, in Martin, Social Aspects, pp ix–​xii. 32 TITMUSS/​2/​161, ‘Labour Party, Minutes 1/​26, September 1958. Minutes of the First Meeting of the Working Party on the National Health Service, 26th September 1958’. 33 TITMUSS/​7/​66, letter, 3 October 1958, RMT to John S. Morgan, School of Social Work, University of Toronto. 34 LSE Staff File/​Titmuss, memo, 22 August 1958, Harry Kidd, School Secretary, to Miss Shrimpton. 35 TITMUSS/​2/​161, typescript,‘Some Points for the Working Party on the National Health Service’, RMT, 4 December 1958, pp 1, 3. 36 TITMUSS/​2/​161, ‘Labour Party. Re.509/​February 1959.Working Party on the National Health Service. Summary of Recommendations’, p 3. 37 The Labour Party, Members One of Another: Labour’s Policy for Health, London,The Labour Party, 1959, pp 5–​6, 6–​7, 8. 38 TITMUSS/​2/​161, letter, 17 August 1959, Herbison to RMT. 39 The Labour Party, Report of the 58th Annual Conference, Blackpool, London, The Labour Party, 1959, p 38. 40 R.M. Titmuss, ‘Foreword’, in J. Vaizey, The Costs of Education, London, George Allen and Unwin, 1958, pp 10–​11. 41 Ibid, pp 10, 6–​7, 9, 7, 10, 7.

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13 Pensions and old age Introduction After 1945, life expectancy in Britain continued to rise, partly because of the benefits of the ‘welfare state’, full employment, and the revolution in medical science. While the population as a whole grew, those over 65 years constituted a slowly increasing proportion of the total. In terms of welfare provision, the restructuring of the national insurance scheme in the late 1940s proved problematic. The value of the contributory pension, in any event designed as a subsistence award, was declining thanks to inflation. The scheme’s flat-​rate basis further exacerbated the issue of the pension’s value. Many pensioners remained victims of poverty, and so were increasingly reliant on means-​tested awards. The whole structure had shaky actuarial foundations in that pensions were paid for not by historic contributions but effectively by younger workers. Entitlement to a state pension came at 65 years for men and 60 for women, ages which had no particular economic or medical rationale but which were apparently fixed and inflexible. Although legislated for by a Labour government, there was nothing especially ‘socialist’ about the pensions scheme. Rather, it embodied Beveridge’s liberalism.1 Thus policy challenges persisted. The incoming 1951 Conservative government considered whether targeted, rather than universal, benefits were the way forward. And as John Macnicol points out, the 1950s saw a ‘small but growing lobby of free market opinion … arguing that state pension ages should be raised’. By such accounts, expenditure on pensions was ‘dysfunctional’ as it did not ‘invest in youthful human capital’. Rather, it ‘diverted resources to a non-​working, unproductive section of the population’ which consumed, rather than produced, wealth.2 Titmuss became heavily engaged with these issues, coming to

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be seen as an expert on pensions policy, and in the 1950s in particular worked extensively on the subject.This chapter’s aim is not to deal with every article or memorandum in an often abstruse and technical field. Rather, it seeks to show how Titmuss contributed to broader debates about the place of, and support for, old people in society.

The employment of older people In 1951, the Conservative government set up the Advisory Committee on the Employment of Older Men and Women under the supervision of the Ministry of Labour and National Service. The ‘problem of the increasing age of the population now and in the long term’ had become a concern, a situation further highlighted by acute, nationwide, labour shortages. It was necessary, therefore, to ‘encourage elderly workers to remain in their jobs’ or, if retired, to return to work. Employers were to be urged to retain older workers, and to consider them for outstanding vacancies.There was, moreover, provision in the state pension scheme to defer retirement, and incentives to do so. By remaining in, or returning to, employment older workers would not only support themselves, they would also relieve the ‘burden on younger workers’. The new committee contained representatives from employers’ and labour organisations, government departments, and ‘experts in the medical, welfare and scientific aspects of the problem of age and its effect on capacity for employment’.3 It thus reflected concerns about the labour market as the economy entered its long period of growth, alongside the perception that old age remained a potential ‘problem’. In early 1952, Harold Watkinson, Parliamentary Under-​Secretary at the Ministry, asked Titmuss to join the committee. He was ‘particularly anxious to have the help of a few experts on the medical, social and welfare aspects of the problem’.4 Accepting the invitation,Titmuss told Watkinson’s boss, Sir Harold Monckton, that the ‘problem is an important one’, and he hoped that ‘the Committee will perform a useful function in stimulating interest in the subject and in adding to our knowledge of the social and economic factors involved’.5 Titmuss became an active member of this body, and helped carry its message to a wider public, responding positively to a query in late 1953 as to whether he would speak publicly about the committee’s work.6 For instance, he appeared on a radio programme in early 1955 entitled ‘Life after Sixty’.7 Similarly, in 1954 Titmuss spoke at the Third Congress of the International Association of Gerontology, and, typically, began with a historical reference. Charles Booth was a social investigator who, in

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the late nineteenth century, had identified old age as a major cause of poverty. For Titmuss, Booth ‘always turned a shrewd and critical eye on the pretentious and the patronising’ who sought to ‘impose on old people a pattern of life which they themselves had no thought or intention of following’. Booth’s analysis contained more ‘wisdom’ than was to be found in ‘most of the garrulous gerontological treatises that fill our library shelves today’. Unlike the latter, Booth’s ‘whole philosophy stemmed from a concern with the individual old person’. Discussing the health of the elderly, Titmuss claimed that old age did not ‘create new problems of health; it only deepens old ones’. He next addressed matters more directly related to the Advisory Committee’s work. Those wishing to remain in employment should be free to do so beyond retirement age. But, crucially, they should not have to do so simply through economic necessity.Titmuss also questioned the commonly held notion that family responsibility for its older members was being weakened –​there was little evidence either way. In any event, many older people did not have children to whom they could turn. It was among this latter group that ‘many of our most difficult problems arise in relation to medical care, housing, social welfare, and all the sustained effort’ necessary if such individuals were to be ‘assisted in living independent lives in their own homes’.8 Titmuss’s positive participation in the Advisory Committee was evident from its first meeting, with him and another member suggesting that ‘pension schemes had psychological effects and these extended to people outside the scheme’. Titmuss also argued, throwing in an especially esoteric piece of information, that the Belgian Coal Mine Scheme provided a model of how incentives to postpone retirement could be enabled.9 The comment about welfare provision’s psychological impact was typical Titmuss. As he told his old friend Le Gros Clark, the problem of ageing ‘was not primarily a medical one’. So little was understood about ‘the physiological and psychological processes’ involved that it would ‘be dangerous at this stage to invest medicine with too much authority’. Unfortunately, this was presently happening for ‘all sorts of proper and improper reasons’.10 Titmuss had a point. As Pat Thane shows, at this time almost ‘nothing was known of the “normal” health potential of older people; to what degree and in what ways, if at all, old age was unavoidably associated with ill-​health, or whether certain conditions were specific to, or more prevalent in, old age’.11 Titmuss therefore pressed for further research. In spring 1954, for example, he urged that more attention be paid to morbidity, given that little was known of ‘the states of health and sickness among men and women over the age of 60’.12

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Titmuss was, it seems, a valued member of the Advisory Committee. In November 1955, Watkinson thanked him for his contribution, claiming that since its formation the committee had made ‘considerable progress’.13 In reality, though, its momentum had stalled, and it was wound up in 1958 (although aspects of its work continued into 1961).Titmuss clearly thought this was because of lack of government concern. He wrote to the Ministry in 1958, arguing that the problems which the committee had identified had not gone away. Consequently, he had concluded that the government was ‘indifferent to the special needs and difficulties of the older worker’.14

Titmuss and Beveridge If the Advisory Committee’s fate was disappointing, Titmuss himself was now established as an authority on old age. In November 1953 Beveridge contacted him ‘in the hope of being able to have a talk with you’ about provision for old age. Beveridge was due to give evidence to the Phillips Committee, set up to consider (as its brief revealingly put it) the ‘Economic and Financial Problems of the Provision for Old Age’. Beveridge passed on a copy of his memorandum to Titmuss, and proposed a meeting at the House of Lords, which appears to have taken place. He also suggested that Titmuss give evidence to the Phillips Committee ‘or be asked to investigate special problems on their behalf ’.15 Nothing seems to have come of the latter suggestion, but what is revealing is that the individual popularly described as the architect of the ‘welfare state’ saw Titmuss as a fellow expert in the field. Beveridge’s respect for Titmuss was not, however, reciprocated.Titmuss’s files contain a copy of an article by Beveridge, published in 1954.Alongside this cutting is a Titmuss manuscript, undated but entitled ‘Beveridge 1942 in 1954’, so it is reasonable to see it as prompted by Beveridge’s piece. Titmuss had clearly gone through the 1942 Report with a critical eye. So, for example, he noted of its pension proposals, ‘More muddle on insurance “principles” ’. Beveridge’s suggestions: ‘Clashes with social policy. Receipt of full pension must depend on contributions!’16 All this was of a piece with Titmuss’s argument, noted in Chapter 11, that while Beveridge had provided a ‘map’ for the 1930s, this was now critically out of date. A questioning approach to Beveridge, and to the pensions scheme put in place after 1945, was to become commonplace among Titmuss and his colleagues. In 1955, for instance, he traced present concerns with an ageing population, and the implementation of pensions policy, back to what he saw as certain erroneous, but still influential, suppositions

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on Beveridge’s part. None of these had transpired, but they explained in part the ‘relative harshness of the Beveridge pension proposals’ and the notion of the ‘burden of ageing’.17 Crossman was later to comment, to an audience containing Titmuss, that in the early 1950s the latter was still a ‘ “back-​to-​Beveridge” man who believed pensions should not depend on contributions’. By the mid-​1950s, though, ‘one of the great creative minds of our social services’ and ‘two of his ablest researchers, Abel-​Smith and Townsend, had begun to clearly identify the fundamental flaws in the Beveridge scheme’.They had concluded that there should be a new pension scheme involving earnings-​related contributions, and earnings-​related payments. This was, Crossman suggested, ‘a revolutionary concept’.18

‘The Age of Pensions’ Titmuss began laying out his analysis in two articles, collectively entitled ‘The Age of Pensions’, in The Times in late 1953, shortly after his correspondence with Beveridge. Some of the ideas he explored were not only indicative of how his thought was developing, but also fed into ‘The Social Division of Welfare’.The first piece started by noting that the ‘extraordinary growth’ in various forms of pension schemes had multiple causes, but one outcome was that, for more and more people, ‘work and death are becoming increasingly separated by a functionless interregnum’. Titmuss next discussed the first of his three categories of pensions, that provided by social security. Around two thirds of the National Insurance Fund was spent on retirement benefits.The scheme involved flat-​rate contributions and flat-​rate benefits. The former fell ‘regressively on contributors, in particular those with families and on the younger workers’.These had to pay ‘higher contributions to meet claims from other sections of the population who did not or could not contribute in the past’. This weekly pension was subject, where appropriate, to taxation. The second type of pension was that enjoyed by public sector workers organised in ‘something like 1,000 separate schemes’.As such, they offered a ‘bewildering field for study’.Although taxable, these pensions differed from social security pensions in that they were generally calculated on the ‘peak earnings in life in combination with the number of years of service’. Other features included a non-​taxable lump sum and, in the case of the NHS scheme, the ‘revolutionary innovation of a widow’s benefit’.19 In the near future, Titmuss was to supervise a doctoral thesis on the history of public sector pensions. He provided a foreword to the ensuing book, noting that with respect to ‘definitions of pensions principles’ one of the ‘great

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landmarks in British social policy’ was an 1803 Treasury minute, a ‘State paper as momentous in its day –​and, indeed, for the twentieth century –​as the Beveridge Report’. This had laid the foundations for a ‘comprehensive, non-​contributory and generous public superannuation scheme for civil servants’.20 In the second article, Titmuss turned to private employers’ schemes where, as in the public sector, a ‘situation of confusion’ prevailed.While some were contributory, ‘the general trend’ seemed to be towards ‘non-​contributory arrangements’. The tax situation, meanwhile, was ‘complicated, inconsistent, and arbitrary’. Generally speaking, though, contributions went untaxed. While, in principle, the pensions themselves were taxed, a ‘large and growing number of private schemes’ were being established ‘for individual employees and approved for tax exemption’.And, as in the public sector, no tax was levied on lump sums. More intricacies followed, but for Titmuss one key point was that, in both public sector and private schemes, it was ultimately the taxpayer who paid the bill. At its simplest, in the case of the public pensions, this was through direct payments to recipients. In the case of private sector pensions, loss of tax revenue was responsible. Social problems of ‘fundamental importance’ were ‘piling up for future generations … as a result of the development of superannuation’. But society seemed both unaware of the implications of such trends and, indeed, that any problem existed. An enquiry was urgently required into ‘the extent, character, and consequences of public and private superannuation schemes, and … the principles and effects of taxation policy upon them’, and the Phillips Committee should undertake this task.21 ‘The Age of Pensions’ had, moreover, also seen a growth in the number and size of funds managed by insurance companies. As money flowed in, these became important sources of investment. But because they were obliged to look to their present and future pension recipients, so the volume of savings ‘seeking investment in risk enterprise’ was in danger of diminishing. Such trends suggested ‘a gradual hardening in the economic arteries of the nation, not only in the field of investment but in terms of occupational and social mobility’. Older people found it ‘more difficult … to obtain employment better fitted to their capacities’. Overall, the ‘division of society into two pensionable categories with retirement rewards based on quite different principles’ suggested that class barriers would remain in place.There were already ‘two nations’ of old age. Generous provision was available for those, mostly drawn from the middle class, in schemes effectively underwritten by public funds. This was not perceived as a ‘social service’. By contrast, those on the

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‘relatively meagre National Insurance pension’, fast becoming ‘the New Poor Law for the aged’, were deemed recipients of a ‘social service’.22 This was powerful stuff, not least in its allusion to Benjamin Disraeli, a nineteenth century Conservative Party leader, and his notion of society as divided into ‘two nations’. It is also interesting with regard to the potential impact on economic performance which Titmuss claimed the current situation might encourage. His analysis of a possible shortage of investment capital thus blamed a rather different source than the Phillips Committee, which argued that the way the state pension scheme was funded would lead to a decline in savings available for investment, and that this was an argument for raising the state pension age.23 In turn, this was part of a broader discussion about how to encourage, and maintain, economic growth. For the Phillips Committee, the solution was to restrict welfare provision. The notion of a potential economic heart attack was picked up by Harold Watkinson, who complimented Titmuss on his articles. Watkinson felt that any publicity which helped ‘bring home to the nation the rapidly growing importance of pension schemes, from many points of view, can do nothing but good’. He was surprised, though, that their committee had not been mentioned, and especially its campaign to ‘make employment practices more flexible’. This was already bearing fruit, and ‘may be expected to help slow down and possibly reverse that gradual hardening of the economic arteries of the nation’. Titmuss replied that the second article had originally mentioned the committee and ‘the barriers to the employment of older people’, but had been cut editorially.24 Whether Watkinson, former businessman and Conservative MP, and Titmuss had the same thing in mind when seeking more ‘flexible’ working practices is open to question, although Titmuss was no great admirer of, for example, what he saw as the corporatism of trades unions. Titmuss was also praised by Le Gros Clark. Replying, Titmuss told him that he was unconvinced that the ‘powers that be’ sincerely wanted to address the general problem of ageing, and in the near future he hoped to ‘explore and test out further the attitudes of the Ministry of Labour’s Advisory Committee and its research satellites to this and allied problems of expanding our knowledge’. Specifically on his articles,Titmuss wrote that, as expected, ‘I am receiving a lot of comments because, I suppose, I was treading on a number of corns; some of them are helpful, some are stupid’.25 Around the same time, Titmuss was invited by the Swedish Welfare Board to contribute to its journal, Sociala Meddelanden.Titmuss duly produced ‘Social Security in an Age of Pensions’, which appeared later in 1954. It concluded with

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a series of ‘Questions for Government’, including whether ‘we are to have two systems of State supported income-​maintenance in old age, one operated though income tax and private insurance companies, the other by way of weekly contributions to a separate insurance fund controlled by the State’. Such questions would be debated in Britain in the coming years, and were part of ‘the general problem of an ageing population’ which raised many important social, economic, and psychological issues stretching ‘far beyond the more narrow field of national insurance benefits’.26 In Social Democratic Sweden, as in Conservative Britain, the future of pensions was under intense discussion at this time.27 Titmuss further elaborated his ideas in 1955 (in the piece which also questioned Beveridge’s assumptions) in Political Quarterly, another journal with strong LSE links, and on whose editorial board Titmuss was to sit from 1960. The ‘problem of ageing’ was, viewed historically, difficult to understand. Huge improvements had been made in life expectancy, for instance, with the working classes now in almost the same position as ‘the more prosperous classes’. But while this should be a cause for satisfaction, ‘we are alarmed by our success’, speaking of a ‘crippling’ burden of old age while forgetting about the costs to, especially, young lives during the Victorian era’s rapid population growth. In the present article, he drew on the findings of the Phillips Committee and ‘five other important state documents which, in one way or another, bear upon the standards of living for old people’. What all had in common was ‘a deep concern about future population trends’. His aim was not policy prescriptions, but rather ‘a broad analysis of contrasting pension systems in the context of population change’.28 Much of what followed was a technical discussion about population trends, and the growth of superannuation schemes. But two points stand out. As in the articles in The Times, Titmuss stressed the broader socioeconomic and political issues involved. He again criticised those who advocated the expansion of, especially, private occupational pension schemes, buttressed by various forms of fiscal advantage. Such proponents were, in now familiar terms, guilty of lightly dismissing ‘the danger of a gradual hardening in the economic arteries of the nation’ caused by ‘the growth of restrictions on industrial and commercial mobility, and from the extension of employers’ control over pension rights’.These ‘new laws of settlement’ might eventually result in obstacles to change ‘as formidable in their own way as the laws which Adam Smith indicted in 1776’.Titmuss was referring here to the provisions of the Old Poor Law, condemned by Smith in The Wealth

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of Nations as discouraging labour market flexibility. This problem was, ostensibly, addressed by the New Poor Law, criticised in one of Titmuss’s pieces for The Times. He had sought to ‘rescue from the obscurity of a mass of technical detail the essential elements in present policies and practices’. A ‘dangerous social schism’ was clearly growing. Social and fiscal policies were moving in a direction which raised ‘fundamental issues of justice and equality’ between citizens. It was already possible to see ‘two nations in old age’.This schism was characterised by ‘greater inequalities in living standards after work than in work; two contrasting social services for distinct groups based on different principles, and operating in isolation of each other as separate, autonomous, social instruments of change’.29 The question was, then, how was all this to be addressed?

The Labour Party and pensions The Labour Party was, by the early 1950s, much exercised about the pension system’s increasingly evident problems. In late 1953, Elchon Hinden of the Socialist Union, a centre-​r ight pressure group within the party, reminded Titmuss that a ‘small group of the Union were working out a Socialist approach to the Social Services’.They had ‘gone through the social services, one at a time, and now have an idea what we think about them’. However, many of their ideas were ‘half-​baked, and not founded on knowledge’, so would Titmuss ‘please come and enlighten us?’Titmuss agreed, asking for list of possible topics prior to their meeting. This was duly produced, and confirms Elchon’s view that his group was not fully on top of its subject, while also illustrating the complexities of the issues involved. Some points were matters of detail, for instance: ‘Since … most of the Old-​age-​pensioners drawing pensions have not contributed to it in full, would it be reasonable to limit the pension to those who need it?’ There was a more fundamental concern however, namely:  were the ‘Social Services merely another method of equalising incomes, in the style of Robin Hood, or is there something more?’ Was there anything in ‘the anthropological approach –​that they exist in order to keep society healthy?’30 These may have been muddled questions, but they were not stupid, and in many ways went to the heart of what the still young ‘welfare state’ sought to achieve. Clearly, though, Titmuss was going to have his work cut out in helping formulate, as he was about to do, Labour’s pensions policy. In 1974, Hugh Heclo, an American scholar who worked with Titmuss on the Finer Committee, produced a comparative study of social security in Britain and Sweden. This included a lengthy discussion of

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Labour’s deliberations from the mid-​1950s through to the early 1960s, and has the advantage of clearly being informed by discussions with LSE participants in Labour’s policy discussions. Heclo’s narrative pointed to the knotty problems of the post-​war state pension scheme. One way out of this logjam was superannuation, that is, an ‘earnings related program comparable to private occupational pensions’. In other words, what you paid in, and ultimately got out, would vary according to income. This was seen as a way of subverting the ‘Beveridge flat-​rate straightjacket’, a common way of describing the constraints of the existing system. Superannuation was promoted by, especially, a ‘group of Labor party intellectuals’, rather than by the Conservatives or by the trades unions which, nonetheless, had plenty to say about what happened to their members in retirement. Enter Titmuss, Abel-​Smith, and Townsend (and later Tony Lynes), and the Labour Party Study Group, for which Titmuss volunteered to produce a draft policy statement. He was to draft a large number of documents for this body over the coming years. By Heclo’s account, presumably acquired from the LSE participants, the Study Group’s meetings were ‘somewhat chaotic affairs’, perhaps a reflection of the then inadequacies of the party’s research infrastructure.31 So how, specifically, was Titmuss involved? In spring 1956 Hilary Marquand, former Labour Minister of Pensions, told him that a Study Group on Security and Old Age had been formed to prepare a policy statement for 1957 Annual Conference. Its first meeting had agreed that Titmuss be asked to serve as a co-​opted member, with Marquand flatteringly suggesting that ‘your informed interest and wide knowledge of the problems which we will be discussing will be of great benefit to us in our deliberations’.32 Abel-​ Smith and Townsend had already worked on pension reform for the Labour Party. In January 1955, Abel-​Smith sent Titmuss his paper for the social services subcommittee of the National Executive Committee (NEC), telling him that perhaps he had ‘stuck my neck out too far’, but that his submission ‘may make them think a bit’. It had been ‘very carefully drafted in the language that the Gaitskells of the world would understand’.33 This slighting reference to the former Chancellor, which Abel-​Smith presumably thought Titmuss would endorse, perhaps places the two of them on the Bevanite wing of the Labour Party as it went through one of its periodic outbursts of internal warfare. Their ally, Crossman, was certainly associated with the Bevanites, at least when it suited him. In any event,Abel-​Smith and Townsend published a Fabian Research pamphlet in March 1955 which argued that pension contributions should be income based, not flat rate, and that various constraints should

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be placed on occupational pensions. All this had a very Titmuss feel to it, and the second of his Times articles was cited in support of the notion of ‘two nations’ in old age.34 Crossman, meanwhile, had floated the idea of what was to become Labour’s superannuation scheme to party conference in 1955, with notable success.35 Crossman later paid tribute to the Abel-​Smith and Townsend pamphlet as providing him with ammunition for his conference intervention.36 Townsend further contributed through information gathered while researching old people and family life in London’s East End, and fed Titmuss material for use on the Study Group. In July 1956 he provided a summary of income data he had devised, and left it to Titmuss as to ‘whether it would be useful to present this’ to the group.37 Townsend’s findings were published in 1957, and he particularly thanked Titmuss, claiming that he had ‘learned most about the discipline of research from Professor Titmuss and his predecessors in the best tradition of English empiricism’.38

National superannuation The Titmuss group had come to acknowledge that, were earnings-​ related contributions to be introduced, this would also necessitate earnings-​related benefits. But they also sought an end to pensioner poverty, an aim not necessarily compatible with varying awards. Not for the last time,Titmuss and his colleagues were faced with the tension between individual equity and increased equality. More immediately, Titmuss was closely involved with Labour’s policy making process.The development of Labour’s pensions policy was, though, a convoluted process. Next we highlight particular issues in the context of various Titmuss preoccupations –​his hostility to private occupational pensions, his concern about ‘two nations’ in old age, and the dilemma of the equitable treatment of individuals versus the ending of poverty in old age. The aim is, therefore, less to analyse the technicalities, and more to illustrate the Titmuss approach which informed them. In summer 1956, at the first meeting of the Study Group attended by Titmuss, Crossman asked how a state superannuation scheme could run alongside those organised privately.Titmuss’s response was that any national scheme should be ‘so satisfactory that the employers would have no incentive to run their own schemes in competition’. If private and state schemes were to coexist, however, then in the case of the latter ‘it would be necessary to take [private benefits] into account when paying out national benefits’. As to underlying principles, ‘it was now necessary to accept differential benefits and contributions’ in a national

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superannuation scheme, although issues such as whether membership should be compulsory would have to be addressed.39 For the next meeting Titmuss produced a document which claimed that, assuming full employment persisted, ‘some of the major issues of social justice in the next ten years will centre round the dependent situations of childhood and old age’, for at both these life stages there was growing inequality, and ‘the increasing rigidity of class and occupational divisions’. And if living standards continued to rise, then for the elderly the key issue was ‘pension justice’.This would not be gained ‘simply by sharing out a little more of current resources by raising retirement benefits’.40 At the meeting itself, Titmuss encountered opposition. Another member, W.H. Clough, claimed that ‘graded benefits’ were not ‘in accordance with the best socialist principles’, since ‘socialism fought for equality of incomes, and also, therefore, in old age’. Crossman retorted that this was questionable as a socialist principle, since nobody argued for equality of wages. Titmuss then suggested that although ‘differentials in working life’ had to be accepted, ‘we can narrow differentials in old age’. The standard of living in old age should, moreover, reflect ‘the needs of pensioners’. Any new scheme of national superannuation should be compulsory, and it was necessary to ‘break the power of private insurance’. Appealing to expertise, he proposed that the group aim for an agreement on general principles, while ‘another group of people … study the more technical aspects of the matter, for perhaps two or three years’.41 This was the origins of the ‘technical sub-​committee’ which was now to do much of the heavy lifting around policy detail. Clough’s intervention, meanwhile, is a reminder that for many in the labour moment flat-​rate contributions embodied both egalitarianism and an easily understood system. Also in July 1956 Titmuss produced another document, clearly based on Townsend’s work in East London. Among the conclusions he drew from his colleague’s material was that ‘old people had special needs, not covered by national assistance grants’, that is, means-​tested benefits. These included chiropody and care of grandchildren. Although not the remit of any particular social service or state benefits, old people regarded them as ‘social or personal necessities’.42 Titmuss continued to contribute to Labour’s developing pensions policy as the 1957 Annual Conference approached. In January he was among those invited to explain the Study Group’s findings to the party’s Home Policy Committee.43 Crossman, keen to present a united front, and to allocate particular contributions to particular individuals, held a lunch prior to this meeting attended by, among others,Titmuss, Marquand, and Harold Wilson.At the meeting itself the

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Titmuss position, which as Crossman recorded favoured compulsory membership for new entrants to a national superannuation scheme, found a vocal supporter in Aneurin Bevan. Bevan, although he had not actually read the relevant papers, nonetheless ‘had an instinct that this [compulsion] was the real point and violently backed Titmuss’. Swayed by Bevan’s contribution,Titmuss’s proposal gained unanimous support. Given that Titmuss himself had not said much at the meeting, this was an impressive result.44 A few weeks later, an internal party document, while anonymous, nonetheless bore a strong Titmuss imprint, identifying, for instance, ‘The Two Nations in Old Age’. On the one hand, there was the ‘privileged minority’ in occupational pension schemes, on the other,‘the two thirds of the working population … still outside any kind of superannuation’, and unlikely ever to be beneficiaries of a private scheme.45 A sense of the febrile atmosphere in the Labour Party is captured in a letter, in March 1957, from Abel-​Smith to Titmuss, in the early stages of his first American visit. The situation on ‘the pension front’ was shifting quickly, with much manoeuvring taking place involving Crossman and Wilson.The former sought a new document to present to Gaitskell, now party leader and still in dispute with the Bevanites, with an appendix signed by Titmuss, Abel-​Smith, and Townsend so as to give credibility to the party’s proposals. Abel-​Smith thought that Wilson might be willing to go along with this on the grounds that any report would be credited to Titmuss rather than Crossman, thereby undermining Crossman’s position.Abel-​Smith would draft an appendix and sign it on Titmuss’s behalf, if he agreed.The letter concluded with an insight into how even supporters of Crossman, nicknamed ‘double-​ Crossman’ before he entered Parliament, viewed him. Abel-​Smith was ‘sorry to have to burden you with all this almost as soon as you arrive but you know what Crossman is. After four days at sea you may feel you have gathered up enough strength to cope with all this’.46 To be fair to Crossman, his purported ally,Wilson, was himself no stranger to the dark arts of politics.The documentation duly materialised,Wilson having told Crossman that such a manoeuvre would mean that ‘We shall get all the kudos for their research and [Titmuss, Abel-​Smith, and Townsend] will have to be responsible for all the detailed figures’.This was then agreed by Gaitskell.47 In May, Morgan Phillips, Labour Party General Secretary, wrote to Titmuss, on behalf of the NEC, expressing the ‘most sincere thanks for the work that you and your assistants have done’ in preparing the National Superannuation policy statement. Exercising the caution of the political official, Phillips remarked that so far ‘this statement seems

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to have been well received by most people who have commented on it’. It would be put before the autumn conference at Brighton, and Titmuss was offered tickets to attend.The Study Group would continue its work over the coming months, and there would be ‘continuing discussions with the TUC [Trades Union Congress] and other interested bodies on various aspects of the proposals in the policy statement’.The NEC would thus be ‘very grateful if you will continue to help us by remaining a member’. Titmuss accepted both offers.48 The policy statement, National Superannuation, ran to over 120 pages and was, predictably, complex. It had two parts: an NEC policy statement, and a ‘Memorandum by a Technical Sub-​Committee on the practicability of introducing a National Superannuation Scheme in Great Britain’, a body chaired by Titmuss.The memorandum, authored by Titmuss, Abel-​Smith, and Townsend, took up two thirds of the document, and included an appendix on ‘Sources and Methods’. The NEC contribution made clear that Part I was ‘a policy statement’ for which it took ‘full responsibility’, while Part II was a ‘report for which the three members of the technical sub-​committee are responsible’. The NEC again recorded ‘its profound gratitude’ to Titmuss and his colleagues. It suggested ‘that this booklet is not the last word on the subject but a blueprint submitted to the British people for examination and review’.The subcommittee, meanwhile, noted that its task had been to ‘construct a working model of a National Superannuation Scheme in order to illustrate the general principles laid down in the first part of this booklet’. Its investigations had convinced it that the ‘principles laid down in the policy statement can be implemented’, and that such a scheme would not be ‘an impossible burden on the economy. On the contrary, the economy was ‘more likely to be strengthened by the substitution of a national superannuation scheme for the present system of financing retirement pensions’. Like the NEC, Titmuss and his colleagues stressed that this part of the booklet was exclusively their responsibility.49 Examples of the extensive press coverage the document received can be found in The Times and The Economist. The former outlined the plan in dispassionate detail, noting the contribution of Titmuss, Abel-​Smith, and Townsend in producing a model pensions scheme.50 It may have helped that Titmuss’s old friend Lafitte was still working for this newspaper. The Economist was more acerbic, in a piece entitled ‘Something for How Much?’The party’s statement was ‘in part proudly proprietorial, in part cautionary, and in some part purely escapist’.The proposals were given respectability by the inclusion of ‘a technical report by Professor Richard Titmuss and two of his professional colleagues’.

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But while Titmuss sought to ‘balance his scheme by provisions that might not be too smoothly popular, Labour mutters hastily that it will have to consult the TUC about them’.51 The last point was a further reminder that not all in the labour movement went along with superannuation, although in the end it gained majority support.52 Reflecting on progress up to spring 1957, Crossman gave a self-​ serving, but useful, insight to Labour policy making, and the part played by Titmuss and his colleagues. He acknowledged their contribution had, for instance,‘provided all the dynamic’, so allowing them to overcome ‘fairly sturdy opposition from Transport House’  –​that is, the building which, at this point, acted as headquarters to both the Labour Party and the TUC. Crossman had backed the ‘Titmuss boys because I had a hunch it would work’. Nonetheless, it would give ‘quite a false impression to say that we borrowed Titmuss’s ideas ready-​made’.With the benefit of hindsight, the ‘striking fact’ was ‘how un-​ready-​made Titmuss’s ideas were when challenged to cook up a scheme’. Titmuss and Abel-​Smith at once realised that they did not have the answers to ‘half a dozen major problems’. By involving them in actual policy making,‘one has accelerated the development of their thought by about ten years’. Without such engagement Titmuss and Abel-​Smith ‘just wouldn’t have had to solve all these problems because, as academics, they haven’t got to provide a finished working plan’. So for the Titmuss group ‘this [has] been a tremendous education, to see the relationship between real politics and their academic study of social services’.53 At the conference itself, the debate on national superannuation included a contribution from Marquand, who paid ‘special tribute’ to the assistance the Study Group had had ‘from a very fine body of experts –​Professor Titmuss, Dr Abel-​Smith, and Mr Peter Townsend –​ who prepared the second part of the document’. Crossman, rounding up, and speaking on behalf of the NEC as well as in his capacity as chair of the Study Group, was even more fulsome. Members of the group had come to know Titmuss and his colleagues very well, and they were presently listening to the debate. The three were ‘not just experts, not just back-​room boys’. It was not ‘an exaggeration to say that the philosophy Professor Titmuss brought with him was an inspiration’ to the whole group ‘in trying to think forward along the way to new ideas in social policy’. So the conference ‘really owes a debt to these three men’.The published report also included a passage thanking the Titmuss group on the NEC’s behalf.54 The News Chronicle outlined Crossman’s speech. In a future Labour government his role would be to raise pensions immediately by £3 per week, and introduce a ‘half-​pay on retirement superannuation

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scheme’. Crossman’s ‘beaming colleagues on the platform’ had led the enthusiastic ovation for his address, looking as if, like Crossman himself, they were convinced that the plan would return them to government. It had trades union backing, although opposition remained on the grounds that wage inequalities would persist into old age. Nonetheless, as Crossman returned to his seat ‘the party leaders all turned to applaud him –​Mr Gaitskell full of smiling approval from behind his sun-​glasses’. And on the seats behind the platform ‘were the three backroom experts who had helped Mr Crossman design the scheme –​Professor Richard Titmuss, Dr Brian Abel-​Smith, and Mr Peter Townsend’.55 The government was hardly going to let all this go unchallenged. At Conservative Party conference, held shortly after Labour’s, Minister of Pensions and National Insurance John Boyd-​Carpenter told delegates that any statement he had to make on pensions would be made first to Parliament.This did not, though, stop him attacking Labour’s proposals. These, produced by Crossman and his ‘skiffle-​group of professors’ –​an allusion to a contemporary popular music craze –​were ‘riddled with inaccuracies’ and had blunders on ‘a considerable scale’. Looking to the future, the Conservatives would continue to encourage private occupational schemes while acknowledging that it was the ‘duty of a modern State to provide a basic provision through national insurance for old age’.56 Boyd-​Carpenter’s comments prompted a letter from Crossman which sought to distinguish between the agreement reached at the party conference, and the technical memorandum. This was, of course, correct enough, although, given the input to Labour’s deliberations by Titmuss and his colleagues, not entirely convincing. Notwithstanding problems of data collection, ‘it had been generally agreed by those competent to judge’ that Titmuss, Abel-​Smith, and Townsend had done ‘a very thorough piece of work’. Crossman also pointed out that Titmuss and Abel-​Smith had worked on the Guillebaud Report, whose findings were ‘not questioned by the Minister of Health’.Titmuss was, moreover, a member of the National Insurance Advisory Committee (to which he had been appointed in 1953) which ‘advises Mr Boyd-​Carpenter!’ Crossman concluded that a ‘Tory Minister who tries to discredit the Labour Party’s superannuation plan by challenging the technical competence of these three men may merely succeed in making himself look rather silly’, a typical Crossman put-​down.57 But it was clear what he was trying to do –​distinguish between political choices and (supposedly) disinterested expertise. Titmuss and his colleagues were similarly unwilling to let Boyd-​ Carpenter off the hook. They, too, wrote to The Times. The basis of

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the minister’s criticisms had been an alleged underestimation of the expenditure, and an overestimation of the income, of the proposed scheme.The three disputed this at length, but the essence of their argument was that old bugbear of Titmuss’s, poor or non-​existent official statistics. In view of the ‘paucity of the information needed to prepare accurate financial estimates’, it was ‘perhaps disappointing that the Minister himself was unable to provide some of the basic figures when asked to do so in the House of Commons before our appendix was published’. Nor had he produced any data since. But Boyd-​Carpenter himself had presumably done his own calculations. So if he held ‘better information upon which such estimates can be prepared’, it would be helpful were this to be published, along with the ‘basis of his calculations in the same detail as we have published ours’.58

Welfare professor Titmuss continued to work on issues around old age and pensions for the rest of the 1950s, and into the early 1960s. In a 1957 essay, he remarked that the ‘increasingly complex problem of pensions and superannuation, public and private’, seemed likely ‘to disturb the reign of the flat-​rate principle in the continuing history of social security in Britain’. This piece was a commentary on the memoirs of a civil servant central to the introduction of national insurance before 1914. Titmuss commended the ‘administrative courage … this willingness to take risks’ which proved so supportive to the minister responsible, David Lloyd George. The latter in turn had to struggle with a ‘reluctant Cabinet, a suspicious Trade Union and socialist front, a rapacious Industrial Assurance world and a venomous Press’.59 Titmuss probably wrote this thinking, ‘how little some things change’. In summer 1958, meanwhile, he was appointed an ‘expert’ for a seminar to be held in late October at Königswinter, near the West German capital, Bonn.The event was being organised by the European Office of the United Nations on the theme of ‘The Individual and Social Importance of Activities for the Elderly’. The invitation came from Kay Midwinter, chief of the UN’s European Welfare Programme. In fact, Midwinter sent Titmuss two letters, a formal invitation and a more personal, handwritten, message.The former noted that among the other participants were to be Townsend and Le Gros Clark. In her more informal note, Midwinter told Titmuss that she had been encouraged to hear that his health had improved.This referred to a bout of tuberculosis Titmuss suffered in the late 1950s, noted at various points in this volume as highly disruptive of his life around this time. She and

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Abel-​Smith had been ‘so anxious’ about him during Abel-​Smith’s recent visit, and regretted that he and his family had not been able to join them. An impending spell in hospital might be ‘dreary’, but would at least ‘force you take things more easily’.60 Midwinter was an interesting individual. The first female clerk of the House of Commons, she also worked for various ministries during the Second World War. It seems likely that she first encountered Titmuss then, and her informal note is that of a close friend. Her invitation is further evidence, though, of Titmuss’s standing, abroad as well as at home, as an expert on old age. Back on the British political front, Boyd-​Carpenter implemented his own plans, resulting in the 1959 National Insurance Act, with its extremely limited earnings-​related provisions.These were denounced, unsurprisingly, by Labour, and pensions policy was an issue in the 1959 general election.61 One criticism of Labour’s 1957 plan was that it would be inflationary, an issue addressed by Titmuss in July 1959, that is during the run-​up to the election. In many existing schemes employers’ contributions might be as high as 20 per cent, so there was no case ‘for saying that a 5 per cent contribution from employers under Labour’s scheme was an inflationary move’.62 At the 1959 conference, the work of Titmuss and his colleagues on the Study Group was again acknowledged.63 A further recognition of Titmuss’s status, especially regarding pensions, came with the 1959 profile in The Observer,‘Welfare Professor’. This started with Labour’s claim that ‘Retirement from work must not mean poverty’, the ‘biggest single promise’ it was making for the future. Such a proposal was the ‘only piece of fresh policy-​making that the party had done since the war’. Its principal author was a ‘haggard professor at the London School of Economics’, who had been called ‘the Labour Party’s one-​man Civil Service’.Titmuss was the academic who had had ‘the most direct and important influence on the party’s programme for the next election’. Without someone like him no opposition party could hope to prepare ‘draft legislation in this complex field that is workable and not just well meant’. While everyone knew that retirement on half pay was desirable, it was Titmuss and his team which had ‘set out to prove it might be possible as well’. The Conservatives had followed Labour on pensions, but Titmuss had been ‘the first prospector in the field’.64 The piece in The Observer was unsigned, but it is revealing to compare it to an entry in Crossman’s diary about a year later, with both pieces stressing the originality of Titmuss’s thought. Crossman recorded that had recently had a meeting of his ‘social security working party’, of which Titmuss,Townsend, and Lynes were members.This group’s output was ‘Quite literally the only

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constructive thinking in the Labour Party that has taken place since the Election’.65 Yet however important Titmuss’s contributions, these were not going to be implemented any time soon. The profile in The Observer came six months before the Conservatives were returned to power in October 1959, the election to which Crossman alludes. Electoral defeat notwithstanding,Titmuss kept working on pensions policy. In May 1960 he told the Study Group that, because of the ‘considerable expense’ involved in contracting out of any national superannuation scheme, ‘many employers were now having second thoughts’. The party should take advantage of this, and announce that any Labour government would ‘radically improve the rates of benefit in the state graded scheme’. It was then agreed that he and Crossman ‘jointly prepare a statement to be considered by the NEC for publication’.66 The following spring, Titmuss reported that Labour’s draft social security plan, with its proposal for an income guarantee, should be seen in the light of ‘the principles in National Superannuation’, retained in the current document. Overall, the plan ‘contained a considerable redistributive effect, increased the flat-​rate pension and would return National Assistance to its originally intended function as a residual service’. As to the administrative complexities of operating a scheme based on lifetime earnings, these had been overcome in the US ‘with even greater numbers to deal with’. There was ‘a psychological difference between the resistance to a huge administrative machine to work a “mouse of a scheme” and one to work a generous and imaginative scheme which would justify the vast administrative machine at Newcastle-​on-​Tyne’.67 Newcastle was the location of a large Ministry of Pensions office complex, while a ‘mouse of a scheme’ alludes to Iain Macleod’s comment in the Commons, in January 1959, that Boyd-​ Carpenter’s pension proposals were too small and too timid, ‘a little mouse of a scheme’ –​hardly a ringing endorsement of his colleague’s plans.68 When Labour’s new proposals were made public, the Daily Mirror described it as a ‘revolutionary plan to take poverty out of the lives of millions of people’, including the old. The ‘big brain’ behind all this was Titmuss.69 This was perhaps the only time he shared prominent newspaper coverage with Christine Keeler, the model who had been having a relationship with Conservative government minister John Profumo.

Conclusion Especially in the 1950s,Titmuss devoted considerable energy to issues surrounding old age. He quickly came to be seen as an expert in the

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field, not least by the Labour Party. How effective all this was is more problematic. As we shall see in Chapter 25,Titmuss was to be involved in updating the original national superannuation plan in the late 1960s. But Labour lost office before this could be introduced, and it was not until after Titmuss’s death, and that of Crossman, that an earnings-​ related scheme was fully implemented.Titmuss continued to concern himself with pensions and old age into the 1960s, but this tended to be woven into his questioning of ‘The Affluent Society’, and his growing concern with various forms of inequality. Similarly, he continued to advise the Labour Party on social policy matters, but increasingly across a wider range of issues. Notes 1 P.Thane, Old Age in English History: Past Experiences, Present Issues, Oxford, Oxford University Press, 2000, p 368ff, and statistical data. 2 J. Macnicol, Neoliberalising Old Age, Cambridge, Cambridge University Press, 2015, p 29. 3 Ministry of Labour and National Service, Report for the Year 1951: Cmd 8640, London, HMSO, 1952, p 21. 4 TITMUSS/​1/​2, letter, 12 February 1952, Watkinson to RMT. 5 TITMUSS/​1/​20, letter, 15 February 1952, RMT to Monckton. 6 TITMUSS/​1/​20, letters, 18 December 1953, Ministry of Labour and National Service to RMT, and 30 December 1953, RMT to Ministry of Labour and National Service. 7 TITMUSS/​1/​21,‘Minutes of the Meeting of the National Advisory Committee on the Employment of Older Men and Women, 24th February 1955’, p 2. 8 R.M. Titmuss, ‘Some Fundamental Assumptions’, Old Age in the Modern World:  Report of the Third Congress of the International Association of Gerontology, London 1954, Edinburgh, E. & S. Livingstone, 1955, pp 45–​9. 9 TITMUSS/​1/​21, ‘Minutes of the First Meeting of the National Advisory Committee on the Employment of Older Men and Women, 2nd April 1952’, p 4. 10 TITMUSS/​1/​22, letter, 5 October 1953, RMT to Le Gros Clark. 11 Thane, Old Age, p 440. 12 TITMUSS/​1/​22, letter, 27 April 1954, RMT to Ministry of Labour and National Service. 13 TITMUSS/​1/​2, letter, 30 November 1955, Watkinson to RMT. 14 TITMUSS/​1/​2, letter, 21 November 1958, RMT to Richard Wood, Parliamentary Secretary, Ministry of Labour and National Service. 15 TITMUSS/​2/​85, letter, 30 November 1953, Beveridge to RMT and attached document ‘Committee on the Economic and Financial Problems of the Provision for Old Age: Memorandum by the Lord Beveridge’. 16 TITMUSS/​2/​85, clipping, Lord Beveridge, ‘Providing Security for Old People’, The Listener, 2 December 1954; undated manuscript, RMT, ‘Beveridge 1942 in 1954’. 17 R.M. Titmuss, ‘Pension Systems and Population Change’, Political Quarterly, 26, 2, 1955, p 153ff. Reprinted in Essays on ‘The Welfare State’. 18 Crossman, The Politics of Pensions, p 11.

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Pensions and old age 19 R. Titmuss, ‘The Age of Pensions I –​Public Service Provision for Retirement’, The Times, 29 December 1953, p 7. 20 R.M. Titmuss, Foreword, in M. Raphael, Pensions and Public Servants: A Study of the Origins of the British System, Paris, Mouton and Co, 1964, p 15. Reprinted in Commitment to Welfare. 21 R. Titmuss, ‘The Age of Pensions II –​Superannuation and Social Policy’, The Times, 30 December 1953, p 7. 22 Ibid. 23 Macnicol, Neoliberalising, p 29. 24 TITMUSS/​1/​20, letter, 31 December 1953, Watkinson to RMT; and letter, 5 January 1954, RMT to Watkinson. 25 TITMUSS/​1/​22, letter, 5 January 1954, RMT to Le Gros Clark. 26 TITMUSS7/​6 2, letters, 19 February 1954, Erland v.  Hofsten, Kungl. Socialstyrelsen, Statistika Byran, Stockholm, to RMT, and 6th July, 1954, Sten Kruse, Editor, Sociala Meddelanden, to RMT. Typescript of article, pp. 14–​15. 27 H. Heclo, Modern Social Politics in Britain and Sweden:  From Relief to Income Maintenance, New Haven, CT,Yale University Press, p 234ff. 28 Titmuss, ‘Pension Systems and Population Change’, pp 152–​60. 29 Ibid, p 166. 30 TITMUSS/​7/​62, letter, 25 May 1953, Hinden to RMT. 31 Heclo, Modern Social Politics, pp 257, 258, 227, n 1, 259, 260–​61. For Abel-​Smith’s involvement, Sheard, The Passionate Economist, p 93ff. 32 TITMUSS/​1/​9, letter, 18 April 1956, Marquand to RMT. 33 TITMUSS/​1/​9, letter, 26 January 1955, Abel-​Smith to RMT attaching Labour Party Memorandum, R.460/​January, 1955, ‘A New Pension Scheme. By Brian Abel-​Smith’. 34 B. Abel-​Smith and P. Townsend, New Pensions for Old: Fabian Research Series No 171, London, The Fabian Society, 1955, pp 27, 7. 35 S. Thornton, Richard Crossman and the Welfare State, London, Tauris Academic, 2009, p 56. 36 Crossman, The Politics of Pensions, p 11. 37 TITMUSS/​1/​9, letter, 6 July 1956, Townsend to RMT. 38 P. Townsend, The Family Life of Old People: An Inquiry in East London, London, Routledge and Kegan Paul, 1957, p vii. 39 TITMUSS/​1/​10,‘Minutes of the Second Meeting of the Study Group on Security and Old Age, 27 June 1956’, p 2. 40 TITMUSS/​1/​10, Labour Party Memorandum, Re 83/​June, 1956, ‘Study Group on Security and Old Age. The Future Development of Pensions and Superannuation. By Professor R.M. Titmuss’, p 1. 41 TITMUSS/​1/​10, Minutes of the Third Meeting of the Study Group on Security and Old Age, 4 July 1956’, pp 1–​3. 42 TITMUSS/​1/​9, RMT, Strictly Confidential Memorandum, July 1956, ‘Notes on Research Findings Relevant to Development of Pensions Policy’. 43 TITMUSS/​1/​10, letter, 24 January 1957, David Ginsburg, Secretary, Labour Party Home Policy Committee, to committee members. 44 Morgan, The Backbench Diaries of Richard Crossman, entry for 1 February 1957. 45 TITMUSS/​1/​12, Labour Party, Confidential Memorandum, Re 148/​March, 1957, ‘Draft Policy Statement on National Superannuation’, p 8. 46 TITMUSS/​1/​12, letter, 29 March 1957, Abel-​Smith to RMT. 47 Morgan, The Backbench Diaries of Richard Crossman, entry for 29 March 1957.

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RICHARD TITMUSS 48 TITMUSS/​1/​10, letters, 28 May 1957, Phillips to RMT, and 4 June 1957, RMT to Phillips. 49 The Labour Party, National Superannuation: Labour’s Policy for Security in Old Age, London, The Labour Party, 1957, pp 2, 52–​3. 50 ‘Labour’s Plan for Pension of Half-​Pay at 65’, The Times, 16 May 1957, p 17. 51 TITMUSS/​1/​12, newspaper cutting,‘Something for How Much?’, The Economist, 18 May 1957. 52 Thornton, Richard Crossman, p 63. 53 Morgan, The Backbench Diaries of Richard Crossman, entry for 3 May 1957. 54 The Labour Party, Report of the Fifty-​Sixth Annual Conference of the Labour Party, Brighton 1957, London, The Labour Party, 1957, pp 113, 119, 32. 55 TITMUSS/​1/​12, newspaper cutting, D. Brown and G. Goodman, ‘Mr Pension Earns Cheers for His Half-​Pay Plan’, News Chronicle, 2 October 1957. 56 Special Correspondent, ‘Conservative Conference’, The Times, 12 October 1957, p 3. 57 R. Crossman, letter, The Times, 16 October 1957, p 11. 58 R.M. Titmuss, B.  Abel-​Smith, P.  Townsend, letter, The Times, 18 October 1957, p 11. 59 Titmuss, ‘A Commentary’, in Bunbury (ed), Lloyd George’s Ambulance Wagon, pp 59, 43. 60 TITMUSS/​4/​622, letters, 19 August 1958, Midwinter to RMT. 61 Thornton, Richard Crossman, p 81ff. 62 LPA, NEC Sub-​Committees, Box 66, Folder ‘Study Group on Security and Old Age, Minutes and Papers 1956–​1961’, Minutes of Joint Meeting of the Finance and Economic Policy Sub-​Committee and the Study Group on Security and Old Age, 21 July 1959, p 1. 63 The Labour Party, Report of the 58th Annual Conference, Blackpool, London, The Labour Party, 1959, p 39. 64 ‘Welfare Professor’, The Observer, 22 March 1959, p 13. 65 Morgan, The Backbench Diaries of Richard Crossman, entry for 20 May 1960. 66 TITMUSS/​1/​13. Confidential Memorandum, Labour Party, Study Group on Security and Old Age, Minutes, 11 May 1960, p 2. 67 LPA, NEC Sub-​Committees, Box 6, Folder ‘Study Group on Security and Old Age, Minutes and Papers 1961–​1964’, Minutes of a Meeting of the Study Group on Security and Old Age, 6 March 1962, p 2. 68 Cited in N. Timmins, The Five Giants: A Biography of the Welfare State, London, HarperCollins, revised edn 2017, p 192. 69 W. Greig, ‘”Half Pay” Pensions: The Labour Plan’, and Staff Reporter, ‘ “Brain” Behind the Big New Plan’, Daily Mirror, 2 April 1963, pp 1, 28.

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14 ‘We have our differences and do not always see eye to eye’: social work and social work training Introduction In his inaugural lecture,Titmuss had set out his plans for his department. These involved moving beyond social work training to developing Social Administration as an academic field. This chapter engages, first, with Titmuss’s views on social work before focusing on the acrimonious dispute, which reached a climax in 1957, resulting from the setting up of the experimental ‘Carnegie Course’ (more formally,‘Applied Social Studies’). The dispute generated a lot of heat, if not necessarily much light. The language in which it is described is revealing. For Dahrendorf, it was an ‘unholy row’ which resulted in ‘much blood [being] spilt’, while one key participant, David Donnison, suggested that the new course’s creation of was a ‘time bomb which was bound to produce major repercussions’.1 It has continued to be a source of debate, with Oakley arguing, in 2015, that the disruption revealed an ‘ordinary man, ill equipped by his education and background and exposure to norms of masculinity to deal with emotional conflict, especially between women, and to treat women respectfully as professional equals’ –​Titmuss. Having said that, Oakley also, quite correctly, notes that there were genuine differences of opinion over the future of social work training.2 As to his handling of events,Titmuss, while generally polite, does not come out particularly well although, with the exception of Donnison, that could also be said of most of the others involved.

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Thinking about social work Titmuss undoubtedly had academic ambitions for his department, but it would be wrong to infer that social work was neglected. His papers are crammed with material on the subject, and throughout his LSE career he participated in social work conferences, and supported social workers, front-​line personnel of the ‘welfare state’, and social work organisations. For instance, in 1953 he spoke on ‘The Family as a Social Institution’ to a national social work conference held at Bedford College, London.Among the other speakers was Conservative Minister of Health, Iain Macleod. Noting that ‘tensions’ were a characteristic of modern life, Titmuss remarked that there must be plenty of these in Macleod’s department, and that when the minister had finished speaking he might ‘probe his unconsciousness and tell us about these unhealthy tensions in Savile Row’. This reference to the home of London tailoring presumably alludes to Macleod’s louche reputation.Turning more directly to his audience,Titmuss flatteringly claimed that ‘both the family and social work are important elements in the modern state’. Unsurprisingly, given its title, his talk was more concerned with the former, but two conclusions which Titmuss drew were of particular pertinence to social workers. First, that training for ‘doctors, nurses, health visitors and those whose work brings them into contact with the family’ had to be closely examined. Second, Titmuss had earlier remarked that one dimension of contemporary life was that ‘we are living in a self-​conscious age’, one in which conformity to dominant social norms was increasingly required. The trouble for those dealing with aspects of human behaviour they might not fully understand, as well as for the modern young family, was ‘how to make self-​consciousness bearable’. So there was a need to ‘underline for social workers in particular the importance of this problem of making self-​ consciousness bearable and to explain why it has become important’.3 On this occasion, Titmuss’s arguments are not easy to follow. But among the related issues he raised were the strains, particularly the psychological strains, of modern life, and the importance for those in the social services of a training which stressed a non-​judgemental approach to their work. Social workers had to acknowledge their own limitations and, implicitly, to engage with their clients on a human level. Titmuss’s address also had a wider impact. He was contacted shortly afterwards by the Bishop of Sheffield who thanked him for passing on a copy of the speech, and intimated that he was going to quote from it in an upcoming Lords debate.4 This he duly did, in a discussion on the ‘Well-​Being of the Family’.The bishop cited not only Titmuss’s recent

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speech, but also his 1948 lecture ‘Parenthood and Social Change’.5 Titmuss had views about what social work should seek to achieve, and how social workers should carry out their responsibilities. He was thus called upon to give advice to various official bodies, for example that of Sir William Jameson which investigated the recruitment and training of health visitors.When this body was set up it was reported that it would have ‘expert advice on social workers and their training from Miss EileenYounghusband and Professor R.M.Titmuss’.6Younghusband and Titmuss were soon to be the principal protagonists in the LSE dispute. Shortly after this ended, Titmuss laid out in detail what he sought from social work in a review of an American text aimed at sociologists and social workers, H.L. Wilensky and C.N. Lebaux’s Industrial Society and Social Welfare. He first praised the authors for embracing a ‘degree of professional self-​analysis which is as remarkable as it is healthy’. Summarising the virtues of the volume’s first section, which dealt with social welfare in the context of American industrial and urban society, Titmuss found it ‘much more realistic and imaginative by comparison with what is usually served up to social work students in Britain in a diet of dreary legislative and economic detail’. This was provocative, given that the LSE was a major provider of social work training.Various other positive features were identified before Titmuss addressed the book’s concluding ‘critical analysis of the development of social work in the American culture and its drive for professionalization’. In another provocative passage,Titmuss suggested that this part of the volume led to a greater understanding of ‘why many trained social workers wish they were psychiatrists; why the creation of a “professional self ” is sought, and how deep-​seated is the conflict of roles thrown up by the clash between humanitarian sentiments and the professional norms of objectivity, impersonality, impartiality and selflessness’. These were, Titmuss claimed, genuine –​‘not imagined’ –​problems for social work in both the US and in Britain. Among the questions they raised were the ‘proper relation of the social worker to the welfare policy-​maker’. While the volume’s authors had offered no solution to these problems, they had appealed for the ‘building of more solid bridges between the professions and the social sciences’. For Titmuss, this insight applied both to social work, and more generally across the professions. Fundamentally, the issue, an ongoing concern of Titmuss’s, was ‘the future role of the professional and expert in the social and power structure of modern industrial societies’.7 Titmuss’s oblique comment about social workers wishing to be psychiatrists illustrates his core belief that those in receipt of social services should not be pathologised –​that is, blamed for their own

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misfortunes. This happened when too much emphasis was placed on behavioural issues at the expense of the socioeconomic environment. Nor was his complaint about the poor quality of British social work texts new. In 1952 he reviewed a manuscript by Sybil Clement Brown and Margaret Ashdown. Titmuss remarked that few equivalent texts available were presently available, so the book should gain a wide market. The ‘reputation of the authors and the general merits of the work’ should likewise help promote it, although the material on the LSE needed updating. This presumably derived from the experience of Clement Brown, a leading figure in psychiatric social work, and previously a key contributor to the School’s Mental Health course. More generally, the ‘lamentable lack’ of suitable material for British social work training meant that ‘too much reliance has to be placed on American text-​books’, but ‘a good deal of this American literature is inappropriate to British needs’.8 Returning to Wilensky and Lebaux’s volume, certain passages expand on its ideas, as summarised by Titmuss. Most notably, the authors argued that in social work the ‘dominant tendency towards psychological individualization’, alongside the ‘flight from reform’, raised the question of the ‘proper relation of the professional social worker to the policy-​ makers and administrators’  –​the point alluded to by Titmuss. This was a complicated issue, but essentially it boiled down to caseworkers, by which the authors meant social workers whose current training stressed their clients’ psychological problems, complaining that ‘the policy-​minded lose sight of the psychological understandings necessary to help the case’.The ‘policy-​minded’, on the other hand, complained ‘that caseworkers lose sight of the community structure’ –​the socioeconomic environment –​‘that creates the case in the first place’. By this account caseworkers also failed to ‘use their case-​history information to shape the size and character of welfare service’. It was at this point that the authors made their plea for closer cooperation between social work and the social sciences.9

Titmuss, Younghusband, and social work training So what provision was there for social work training at the School? On Titmuss’s arrival, around 40 courses were offered under the rubric ‘Social Science and Administration’. Among the more general courses was an ‘Introduction to Social Case Work’, led by a key player in what follows, Kay McDougall.10 In 1959,Titmuss produced a history of social work training at the LSE. The courses presently available combined ‘theoretical study’ of the social sciences with practical field work. The

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former embraced subjects such as economic and social history, economics, and social policy and administration.While courses had lower entry qualifications than those for undergraduates, and while this had led to the notion of ‘inferior standards’, in fact social work students tended to be more mature and more experienced.Titmuss emphasised that the advanced and specialised courses were not ‘vocational training’. Rather, they aimed to illuminate ‘problems arising from these particular fields’. Demand for courses was high, with 225 students presently enrolled, members of staff also contributed to the undergraduate degree, and his department was the largest of its kind in Europe, and almost as large as that of Columbia University in New York.11 Kit Russell, who was working in the department at the time of the social work dispute, co-​authored a history, published in 1981, of students taking courses in Social Administration. Russell and her colleagues found that in 1950–​51 24 graduates had taken the one-​year certificate course, the two-​year diploma course had been taken by 117 students, and 12 had taken the new two-​year overseas course.There were 13 staff consisting of one professor (Titmuss), one senior tutor, ten lecturers, and one assistant lecturer. Apart from Titmuss and two others, the staff were female. Ten years later, diploma courses could be of one or two years’ duration, with the former still reserved for graduates. Over 30 students had taken the overseas options. The overwhelming majority of students remained women, but now 12 of the 20 staff were men.12 In 1950,Titmuss also took over responsibility for two specialist courses. The oldest was that in Mental Health, led by McDougall, someone with considerable standing in her field.The other was led by a likewise well-​respected figure, Clare Britton (later Winnicott), and dealt with Child Care. This was a more recent development, set up post-​war in the wake of concerns such as those expressed by the Curtis Committee. Eileen Younghusband was also on the staff. Although not trained in social work, she was, nonetheless, considered an authority on the subject. She had worked as a voluntary social worker in London, and gained a social science qualification from the LSE, where she became a part-​time staff member in 1929, with her post becoming full-​time four years later. Younghusband had, with the support of the charity the Carnegie UK Trust, produced two reports, in 1947 and 1951, which argued for expanded, and more fully integrated, social work training, and the implementation of a ‘generic’ approach. The latter was based on the idea that the ‘demands on social workers wherever they worked, called for a common core of understanding, knowledge and skill which should inform and influence the various branches of specialised practice’.13 Or, as Russell and her colleagues later put it, what

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came to be the Carnegie course, introduced under Younghusband’s leadership in 1954, was, given the ‘alarming proliferation’ of specialist courses in London and elsewhere, intended to ‘lower the barriers of specialisation’.14 Thus, on his arrival Titmuss found a long-​standing member of staff with strong and influential views on social work’s future. Her particular role at this point was Tutor in Practical Work on the Social Science Certificate course. Younghusband was, moreover, part of an international network of like-​minded female social reformers another of whom, the American Charlotte Towle, was to play a part in the LSE dispute.15 Younghusband had an aristocratic background, was well connected socially, and had a strong sense of self-​belief. Kate Lewis, recruited to assist Younghusband on the new course, was from a similarly privileged background, so arguments about the direction of social work were undoubtedly overlain by friction based on social class and on individual personalities. As Donnison noted of Younghusband, her ‘style and social origins’ allowed her ‘access to the power structure through networks which were personal rather than professional’ and others in the department, lacking such advantages, took exception.16 In his early days at the LSE, Titmuss actively sought to promote Younghusband and her ideas. In early 1952, for instance, he persuaded Lafitte, at The Times, to accept an article by Younghusband on social work training. Lafitte also promised to write a leader on the subject.17 While nothing seems to have come of either, the episode does show that Titmuss was prepared, at this stage, to use his influence to advance Younghusband’s cause. More importantly, in 1951 he had approached the Carnegie UK Trust with a proposal to create an Institute of Applied Social Studies.18 In a memorandum to his staff, Titmuss had outlined his proposal, noting that any resultant body could be seen as analogous to the already existing Institute of Education.19 Such a body for social studies had been one of Younghusband’s own recommendations. But, as the Trust later noted, such a large-​scale project was felt to be ‘outside our competence’. However, the idea of some sort of contribution had not been ruled out.20 Clearly this was conveyed to Titmuss as he and Younghusband were invited, in summer 1952, to informal discussions in Edinburgh with three leading Carnegie representatives. The first was James Wilkie, the Trust’s secretary, and member of the Scottish Council of Social Service. Second, there was Sir Hector Hetherington, Principal of the University of Glasgow, and someone who, as a trustee of the Nuffield Foundation, would have known of Titmuss’s work.The third Carnegie representative was Katharine Elliot (later Baroness Elliot of Harwood), public servant and social reform activist.21 Elliot and Younghusband

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had known each other for some time, and in the 1940s had discussed the possibility of more coherent and expansive social work training and practice. Kathleen Jones speculates that this may have impelled Elliot to press the Trust, of which she was already a trustee, to commission Younghusband’s survey of the social work field.22 Reviewing the Edinburgh meeting, Titmuss noted that ‘some confusion’ had had to be removed from Hetherington’s mind about social science courses and vocational training. But, having ‘changed his views quite remarkably’, Hetherington agreed to five years’ funding for an experimental course to coincide with London University’s five-​year planning cycle and, once the course had been established, that it be financed by the funding allocated by the University Grants Committee.23 Following what Alma Hartshorn describes as a ‘considerable interchange’ between the LSE and the Trust, the latter agreed, in 1953, to fund, to the tune of £20,000 over the life of the grant, a four-​year experimental course. This was to start in autumn 1954 under the name of ‘Applied Social Studies’. As part of his application, Titmuss had suggested that the Child Care course might be merged with the new course as early as academic year 1954–​55, although the Mental Health course might have to be maintained separately ‘for a further period’. Although the merger did not occur at the point envisaged, as Hartshorn observes, the proposal was indicative of Titmuss’s general hostility to one-​year specialised courses. Titmuss had also suggested that, given that the new course would be among the first of its kind in Britain, a Fulbright Scholar should be recruited from the US to give advice on the experiment, while someone from Britain should visit America, supported by a Smith-​Mundt award (a funding scheme in the US), to examine social work training there.24 As Head of Department, it was down to Titmuss to decide who was to run this course. He choseYounghusband. But this was not straightforward. In February 1954 Carr-​Saunders told him thatYounghusband had accepted the post, but in so doing she had also requested promotion to Reader.The director doubted if this was possible, there being a ‘rather thin case’ for such re-​g rading. Certainly, she had written published reports for Carnegie but had she ‘done anything else which could justify thinking of an approach to the University on the matter?’Titmuss scrawled on this memorandum,‘Answered. Not now’.25Younghusband did not get her promotion. Furthermore, Jones suggests that while Titmuss was willing to have Younghusband lead the Carnegie course, he also counselled her to think carefully before accepting, given that she was not a qualified social worker (although, in fact, at this point relatively few social workers received formal training). Nonetheless,

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Younghusband took the task on, and began preparations for the first intake. This included undertaking the already proposed American visit, supported by the Smith-​Mundt Fellowship. Younghusband also recruited one of America’s leading authorities on social work, the University of Chicago’s Charlotte Towle, to come to Britain, as a Fulbright Scholar, to spend a sabbatical at the School to help with the early stages of the course.26 Titmuss grumbled to Carr-​Saunders that he was prepared to support Younghusband’s application for leave, to be taken in 1953, while she undertook her trip. This would be, he stressed, without pay, and her absence would ‘add to our difficulties in the Department’.27 There was a further component to be put in place before the course started.There was to be a Consultative Committee, tasked with liaising between the department and outside bodies with interests in social work training.Titmuss was its chair, and other members included, from the LSE, Janet Kydd, his deputy Head of Department,Younghusband, Lewis,Winnicott, and McDougall. Members from outside organisations included the Ministry of Health’s Geraldine Aves, Sybil Clement Brown from the Central Training Council in Child Care, and Olive Cosse of the Family Welfare Association. This body first convened in February 1954, meeting 12 further times until, in 1957, it fell foul of the dispute between Titmuss and Younghusband.28 It is notable from the records how often Titmuss failed to attend its meetings, and certain of its members were to be upset by his treatment ofYounghusband and Lewis. Nonetheless, so far, so apparently positive. Like Titmuss,Younghusband was hostile to over-​specialisation, keen to promote social work both quantitatively and qualitatively, and to embed training in universities. But problems soon emerged.While McDougall and Britton had been broadly supportive of Titmuss’s Carnegie applications, there was an inherent tension in the project. If the way ahead for social work training was ‘generic’, where did that leave the courses run by McDougall and Britton? Furthermore, it presumably did not help that Younghusband was sceptical of the use of both case conferences, and the over-​use of casework in social work practice. In her view, these encouraged too much specialisation, while often failing to lead to any tangible outcomes.29 MacDougall was a leading advocate of such methods and, as we saw in Chapter 10, set up the journal Case Conference in 1954. Titmuss was clearly aware that none of this was unproblematic, although he might be seen as procrastinating when it came to decisions and solutions. Before Younghusband left for America, he suggested they meet to thrash out various concerns. These included ‘the future role of Kay and Clare in relation to teaching on the Carnegie course’.

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He was convinced that both could, and should, make a contribution. Such issues had to be resolved before other matters could proceed.30 Dealing with the Carnegie Trust also proved highly frustrating. In early November 1953, Titmuss told Younghusband, recently arrived in the US, that starting the course might have to be postponed until 1955, adding that ‘life has had a rather desperate quality these last few weeks’.31 Younghusband, on the other hand, was clearly gaining from her visit. She had informed Titmuss, a few weeks before his letter in which he suggested that delaying the course might be necessary, that she was sitting in on classes at the University of Chicago where Towle was ‘another story altogether’. She was ‘like something out of a story of 19th century New England but with all the modern knowledge added to a first rate, subtle, penetrating mind and a very rich, warm personality’.Younghusband thus had ‘no doubt’ that ‘she would be right for us beyond our dreams’.32 Later in November Titmuss wrote again to Younghusband with a mixed bag of news. He had written to Towle, while his ‘ultimatum’ to the Carnegie, presumably threatening a delay to the course, had resulted in the latter’s ‘complete capitulation’. Nonetheless, the ‘only hope’ of an October 1954 start rested on two conditions. First, that ‘a great deal of the detailed negotiating work (both outside and inside the School)’ be delegated to herself and Kydd, working closely with McDougall and Britton. Second, that Younghusband cut short her American trip, returning in time for the beginning of term in January.33 Younghusband was not happy. She would return if necessary, but to do so would ‘cut into one of the busiest and most profitable pieces of my programme here’, namely various activities in New York City, and a speech scheduled for a social work conference in Washington.34 Titmuss was losing patience with the whole affair. In response, he emphasised that Younghusband had to weigh up the advantages of remaining in America with the possibility of postponing the start of the course, concluding that many of the issues he had raised ‘cannot be organised from New York … I fear that all these questions must await your return’.35 Younghusband, again, did not take this well, construing Titmuss’s letter as implying that she had ‘lost my perspective about things’. She also felt aggrieved. Titmuss’s ‘failure to recognize’ the loss involved in ‘changing the plan which you and I had jointly discussed’, and which would have concluded with her participation in the Washington conference ‘from which so much could have been gained after preliminary months of work here’, clearly concerned her.36 Drawing a draining correspondence to a temporary halt,Titmuss wrote that he was sorry Younghusband would have to curtail her visit. It was

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a pity that ‘we cannot be in two places at once –​I have been trying unsuccessfully to do this for some months’.37 Younghusband did not keep her unhappiness to herself. In January 1954, she received a letter from Helen Roberts, presumably the Helen Roberts with whom she shared a flat in wartime London. Roberts was upset thatYounghusband was ‘going back feeling discouraged about the situation at LSE and the prospects for Carnegie. I  know it is a big disappointment that “Richard” failed to see the importance of your completing your time in the USA’.38 Younghusband’s disappointments were soon to be further compounded by the School’s lack of support for her readership application. The Applied Social Studies course therefore started under a cloud, although there was no problem in recruiting the first 25 students. Nonetheless, trouble was brewing.At the end of its first term, in a letter marked ‘Confidential’, Titmuss wrote to Younghusband. Britton had sent him a copy of a note which she, Britton, had sent toYounghusband. It is not clear what the content of this note was, but from Titmuss’s response we can make a reasonable guess. He was at pains to tell Younghusband that Britton had not consulted him before writing. But if ‘what she says is correct I must tell you I am profoundly shocked’. Should the current situation prevail, ‘then the future of the Carnegie course is indeed bleak’.39 Presumably Britton had raised serious issues about the form, the content, or both, of the course, and subsequent events support this argument.A few weeks later,Titmuss again contacted Younghusband. He had now met with Britton and McDougall. Their collective view was that ‘the three of you must meet together and have a very frank talk’.40 It again remains unclear what they were to have a frank talk about, but, as Donnison remarked in a rather understated way, communication ‘between staff of the new Applied Social Studies Course and [McDougall and Britton]’ was ‘difficult from the start’.41 Charlotte Towle’s delayed arrival, at the beginning of 1955, did little to help. A few months earlier, The Washington Post had reported that she had been rejected for a Fulbright Scholarship by the American government. The LSE had invited her to spend a year ‘organizing and directing a case-​work program built on established American methods’. While no reason had been given for the refusal, it was assumed to be connected with her left-​wing political views, plausible enough given Senator McCarthy’s contemporary grip on US politics. Towle’s plight had caused both Titmuss and Younghusband to resign from the Fulbright Selection Committee.42 Oakley records that Titmuss had to intervene directly so that Towle might belatedly make her trip. She also notes a dinner party given in Towle’s honour at the Titmuss home.43

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This collegial start to her visit was not to last since, as Jones puts it, Towle ‘ran into immediate and marked hostility’ from staff on the two specialist courses.44 For Donnison, Towle’s ‘inflexible commitment to American ways of organising a course’ bolstered fears that ‘an American doctrine was being imposed’.45 Personal antipathy also played a part, with Towle, Younghusband, and Lewis provoking strong, hostile, reactions. For Titmuss, this was a difficult situation to manage. A further complication arose in spring 1955 when the Ministry of Health invited Younghusband to chair a working party on social workers in key local authority services. This produced, in 1959, what became known as the Younghusband Report, among whose recommendations was the further expansion of social work training. But such an appointment was not unproblematic.Younghusband had, Titmuss suggested, a ‘difficult decision to make and one which may have consequences for the future’.Were she to take on this role it would almost certainly take up a large amount of her time for some years. Given that the Carnegie course was due to end its experimental stage within that timeframe, there was a risk that ‘any reduction in the time you can give to the Department may jeopardise the future of the Course and, in particular, its relationship to the Child Care and Mental Health Courses’. This was soon to become a major source of conflict. More immediately, there were also salary implications, for were she to take up the post either the Carnegie trustees, or the LSE, would be paying a ‘full-​time salary for not much more than a half-​time contribution’. Younghusband’s wider departmental role also exercised Titmuss. From his perspective, she should in future ‘play a more important part in the work of the Department than you have been able to do during the past year or so’, especially when compared with other staff. If a satisfactory working relationship between the various courses was to be established, once the early, admittedly demanding, phase of the Carnegie experiment was over, ‘it is important that you be able to give more and not less time’ to departmental activities.46 ButYounghusband was determined to accept the Ministry’s invitation, informing Titmuss of her decision in early June 1955. Responding, he told her that, the assurances she had had from the Ministry notwithstanding, the task she had taken on was both very important and extremely difficult. Younghusband’s assertion that ‘the Director and I  saw no objection to your accepting this invitation’ needed ‘some qualification’, not the last time that one of these two would accuse the other of poor communication (and bad faith). Titmuss reiterated his own, and the School’s, position, namely that there would be no objections ‘so long as this additional commitment along with your

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other outside activities does not conflict with your responsibilities as a full time teacher in the Department’. Some of Younghusband’s other external commitments might have to go.This was for her to decide, but ‘I should have thought that anything above one whole day in five away from the Department might cause difficulties’.47 A week later,Titmuss wrote to Younghusband on her award of a CBE. He sought to add his good wishes ‘to the many I am sure you will deservedly receive’, notwithstanding that ‘We have our differences and do not always see eye to eye’. He also adopted a more conciliatory line regarding her Ministry of Health appointment, suggesting that it would be ‘on academic and other grounds quite wrong for me to dictate to a senior member of my staff how he or she should allocate their time in situations of this sort’. Nonetheless, he had written about her appointment to the Ministry, and it was for her to decide ‘if you can fit this in with your responsibilities to the School’.48 Around the same time,Younghusband told Towle that she planned to urge Titmuss to put the Carnegie course on a permanent basis, with herself as director. This would force him to confront the ‘mucky situation he’s got into’, a reference to the need to merge the Applied Social Studies course with the two specialist programmes. So Younghusband was aiming both to retain, in the short term, leadership of the Carnegie course, and of any merged course.49 As Hartshorn remarks, the path to merger ‘Inevitably … proved far from easy’.Titmuss nonetheless started the process off in summer 1955, at a point when it had already been decided that the Child Care course would run for another three years.50 A few months later, he asked Younghusband, Britton, and McDougall to prepare memoranda outlining future plans. As Donnison notes, there was hope of progress, as each accepted the need ‘for some degree of unification’. Younghusband suggested gradual integration which would, eventually, produce a course with a syllabus similar to that of the Applied Social Studies course. Britton was more sceptical, but would consider a partial amalgamation of her course with Younghusband’s. McDougall, like Britton critical of some aspects of a proposed new course, nonetheless welcomed the idea of a ‘common basic training for social workers’, although the Mental Health course should continue and concentrate ‘increasingly on more advanced students and research in all branches of social work’.51 So there did appear to be the possibility of some sort of rapprochement. At this stage, Carnegie appeared relatively happy with the work it was sponsoring at the LSE. Its 1955 Annual Report reviewed the course’s prehistory, observed that it had been planned in consultation with various interested parties, and that its aim was to produce ‘general

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practitioners in social science … acceptable to employing bodies’. This would help ‘break down the barriers between specialisms …, lead to flexibility in the interchange of social workers between one branch and another without lowering standards, and possibly help … to reduce the number of social workers paying independent visits to problem families’. The first cohort of students had completed the course in summer 1955, and the Trust had received ‘good reports of the progress of the experiment’.52 Underlying problems remained, however. In November 1955 Helen Roberts had been ‘saddened’ by Younghusband’s ‘news that things are being so difficult again at LSE. I have thought of you so much in that connection this past week’. Roberts was anxious for reports of the dinner, presumably aimed at finding some sort of resolution to the crisis, which Younghusband,Towle, and Titmuss had attended, for ‘I can’t feel that the only solution would be for you to resign, since the antagonism to the Course must be something other than any personal reaction to you’. Might it be that ‘some subconscious insecurity or perhaps resentment vis a vis Charlotte, as an American, may have something to do with it?’53 Younghusband was becoming increasingly demoralised and, again, making her views known to friends. In early 1956, she received a letter from Towle, now back in Chicago. ‘In your last letter’, Towle wrote, ‘you said RT’s latest is … Nuts! I can believe that but please specify again!!’ She had heard from another correspondent (probably Kate Lewis) that Titmuss had been ill. This was all he deserved, ‘and as far as I am concerned I need not weep. He could kick the bucket sky high for all I’d care’.54 By this time, as Jones notes, the ‘battle-​lines had been drawn’. On one side there was the self-​designated ‘Three Musketeers’,Towle,Younghusband, and Lewis. On the other stood the ‘Quagmire Quartette [sic]’,Titmuss, McDougall, Britton, and Kydd.55 The implication here was obvious.The first were dynamic and swashbuckling, blazing new trails in social work education.Their opponents were stick-​in-​the-​muds, constrained by inertia and the ways of the past. Events took a new turn in early 1956, when Donnison was appointed to a readership in the department. As he later recorded, Titmuss asked him to address the social work issue, confessing that he himself was ‘at his wits’ end’.56 Donnison was viewed by Younghusband and Towle as a Titmuss stooge, which can hardly have eased his task.57 One incident, in summer 1956, again shows Titmuss andYounghusband’s mutual mistrust.Younghusband found it difficult ‘to answer your note of June 5th about the amount of the new junior’s time which we should require for the Course in Applied Social Studies’. The previous incumbent had resigned because of the heavy workload, and Younghusband

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had contacted Titmuss to tell him that she and Lewis ‘were going to discuss the situation’ with the LSE secretary, Harry Kidd. Although Younghusband did not acknowledge it, she and Lewis were effectively going over Titmuss’s head. Consequently, Kidd had agreed to recommend to the director that a full time junior be appointed to help with the Applied Social Studies course. By Younghusband’s account, she and Titmuss had then ‘discussed this verbally and you asked me to let you know about further developments’.This, she acknowledged, she had not done, although ‘I should equally have taken for granted that you would consult with us before any alterations were made to this arrangement’. The last point referred to an agreement, to which Younghusband and Lewis had not been party, that a junior be appointed, to be shared among the department’s various professional courses.‘I wonder’Younghusband enquired,‘why this arrangement was made without any reconsideration of the very strong case we made for a junior’. She was reiterating her demand that such a person be appointed solely to the Applied Social Studies course. This was necessary for a number of reasons, including the present failure to collect research material ‘which was part of the Carnegie experiment’.58 While on one level it was the sort of trivial incident which plagues working life, on another this spat shows bad faith and failure of communication, deliberate or otherwise, on both sides.

Not what should be done, but who should do it Nonetheless, by late 1956 there again appeared to be the possibility of a truce. The key now was for Titmuss to ‘decide the future pattern’ of the various courses. As Donnison put it, the issue was now ‘no longer what should be done but who should do it’. In other words, integration was to take place but, once this had happened, who was to be in charge? In the meantime, relationships were again deteriorating, with Titmuss claiming that he had been exposed to ‘repeated complaints and several offers of resignation’. As to the leadership question, Britton had ruled herself out, while Donnison likewise did not want the job. Titmuss informed Britton, McDougall, and Younghusband that the three courses would be progressively integrated, starting with the Child Care and Applied Social Studies courses in academic year 1958–​59. And, as of May 1957, McDougall would be ‘Lecturer in Charge of Professional Education for Social Work’. Donnison observed that this was ‘the crucial decision’.59 At the end of January 1957 Titmuss wrote personally toYounghusband. Following various discussions involving a number of staff members, he was ‘still hopeful that we can carry out the new policy without

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too many difficulties arising’.60 Younghusband, however, was not to be mollified. She reminded Titmuss that when she had written to him some three weeks previously she had told him of her support for the unification of the three social work courses. Titmuss had also been informed, though, that ‘for other reasons I had felt my resignation to be inevitable’. She had agreed, at Titmuss’s request, not to do this, in the hope that ‘even at this late point discussion and co-​operation might enable changes, which will in any event cause a good deal of dislocation, to be made as smooth as possible’.The previous Monday, she and Lewis had met with Titmuss, offering to try and find ‘a way through the difficulties’.Two days later, however, ‘without any further consultation with us, we received your memorandum’ –​that is, the document announcing Titmuss’s merger and leadership decisions. Titmuss had already been made aware of their ‘dissent from your decision, together with the way it has been made’. They were, therefore, ‘now sending our resignations to the Director’.61 On the same day, Younghusband accordingly wrote to Sydney Caine, who had just come into post, offering to quit. She told Caine that she warmly welcomed ‘the general plan for unification of the three professional social work courses’. However, ‘certain decisions about future plans for a course for which I am presently responsible, and the ways these have been taken, leave me with no alternative but to resign’. Caine agreed to meet her and Lewis, and deferred acceptance of the resignations.62 Younghusband and her allies were convinced that Titmuss had misrepresented their case to Caine, who, as it happened, was not overly interested in social work education.63 Younghusband, however, was determined to go ahead. A few days later, Donnison told her ‘how sorry I am that you will be leaving us, though I understand and respect your decision.You should know that all those who have taken part in the ghastly proceedings of the last few weeks feel the same way about that’.64 Younghusband’s resignation was accepted,‘with regret’, by the LSE’s governors in early March.65 A few days earlier, Titmuss had told departmental staff that McDougall was to take overall charge of social work training, and that Younghusband and Lewis had resigned with effect from 30 September 1957. Rather ambiguously, he commented that nobody could as yet ‘assess how fully has been their contribution to developments in social work education at the School’. Nonetheless, their resignations would be a ‘most serious loss’. Titmuss’s ‘personal hope’ was that as the Carnegie course’s principles were extended to other programmes, it would be possible for ‘Miss Younghusband and Miss Lewis to continue to be associated with the work of the Department’.66

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The matter, though, did not end there. When Titmuss notified Carnegie of the changes taking place, this provoked a negative, sometimes hostile, response. David Lowe, the Trust’s secretary (and former member of the War Cabinet Secretariat), pointed out that his organisation had not been consulted, and speculated whether any funding would be forthcoming in the future.67 Olive Cosse, meanwhile, told Titmuss that she found his proposals ‘disturbing’. The unification of the three courses was a serious issue, but even more serious was the ‘statement that Miss Younghusband and Miss Lewis have resigned’. It was ‘impossible’ for her ‘to overstate the … anxiety’ of the Family Welfare Association over the proposed changes, and she had been asked to express, on its behalf, its ‘deep regret that the decisions, as outlined in your letter of the 20th February, were taken without prior consultation with the Consultative Committee’.68 One particularly vociferous critic was one P.  Armstrong, of the Suffolk Children’s Department. She told a correspondent (probably Kate Lewis) that among her concerns was that some department members might imagine that ‘Richard is impartial and objective in all this. It’s incredible to think anyone could –​but you never know’. Armstrong speculated that ‘with some people there might be the irrational effect on them of his being Head of Department’.69 She also raised her objections with Caine and with Titmuss. The latter, in reply, told her that after ‘long study’ and discussions with relevant staff members he had decided on the gradual integration of all three courses. McDougall had been asked to initiate discussions with outside bodies over these reforms. He had not envisaged any changes in teaching or staff duties in the short term, and had assumed that Younghusband and Lewis ‘would continue to be responsible for the course in Applied Social Studies, not only for the rest of the experimental period but for as long as it continued independently’. No decision has been taken, or could have been taken, about responsibilities when the courses fully merged. Titmuss concluded that, like Armstrong, he was ‘deeply distressed at the resignations of Miss Younghusband and Miss Lewis to whom we all owe so much’. He hoped, therefore, that ‘some way may be found of associating them with the future development of social work education in this Department’.70 On the same day, Titmuss also wrote to Younghusband. He had written to the Advisory Committee, and attached a copy of his correspondence. Rather plaintively, he asked whether she thought ‘this offers us the chance of a more constructive approach?’ In his letter to the Advisory Committee,Titmuss confirmed the aim of course integration, something which, at least as far as he was concerned, nobody disputed.

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After Donnison had consulted with staff,Titmuss had decided it best to have the integrated course in hands of one person, McDougall. But it had never been envisaged that McDougall would take over the Applied Social Studies or Child Care courses. Planning for all this was to be done by an ad hoc committee ‘of all the staff concerned in the professional courses’, hopefully to be chaired by Donnison.Titmuss conceded that he was ‘aware that some of my actions of the past few weeks may have been mistaken in the sense that they have led to misunderstandings, and I accept full responsibility for any such mistakes there may have been’. He had not, in this letter, tried to explain the complicated background to these decisions, or to justify them. Rather, he had sought to ‘clarify the present confused and unhappy situation, and to lay a foundation for constructive action and better relationships all round’. He would, therefore, do his best ‘to answer any questions that people still want to ask if this will help to dispel misunderstandings that remain, and above all I hope that Miss Younghusband and Miss Lewis may yet feel able to reconsider their decisions to resign’.71 In reply, Younghusband told Titmuss that among the various unresolved issues, the crucial point was that were she to be asked to stay in charge of the Carnegie course, ‘but to work under Mrs McDougall in all the planning and negotiations which must be done if the course is to become permanent’, this would be seen ‘as an expression of lack of confidence in my previous conduct of these negotiations, as well as my general planning of the curriculum, in consultation with the others concerned’.72 Titmuss, no doubt like all the others involved in what Donnison had called ‘the ghastly proceedings’, was getting very tired of all this. His first US visit was imminent (he was due to leave on 28 March), and he confided to Eveline Burns, friend and key American contact, that he had seriously considered cancelling his trip ‘as the pressure of work has been almost intolerable’, promising her the full story when they met.73 There was, though, to be no let-​u p. Titmuss responded to Younghusband’s latest communication, telling her that while he had ‘tried to write as frankly as I can about these personal and domestic issues’ he would like it to be known that ‘the troubles we have had in no way diminish the respect and affection I have for you and Kate’.74 It then transpired that Younghusband had circulated, outside the LSE, her recent letter wherein she had objected to the idea of working under McDougall.Titmuss was understandably annoyed, and not least about such references to other members of staff. He had kept his own reply between the two of them, but perhaps Younghusband might consider letting department members see what she had written.75

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Titmuss also sought to explain recent events to Towle. Her response was hostile, claiming that it ‘must be a relief to you to have placed the generic education adventure in hands responsive to your reservations about it’. When she and Titmuss had discussed the ‘future of the professional courses’, he had suggested McDougall as the likely leader. But Towle’s reservations ‘were never explored by you’. She had left London convinced that ‘you had never entertained any other idea than to turn the generic education project over to the regime responsible for the kind of education, the Carnegie Course (as a pattern setting venture) was designed to correct’. Consequently, she was not surprised by Titmuss’s recent decisions. She was surprised, though, ‘that you regard it as “tragic at this moment in our history that Kate and Eileen have decided to resign” ’.Yet McDougall’s appointment ‘as lecturer in charge of professional education for social work could have had no other outcome. Could you possibly be surprised by this untoward event?’Towle conceded that she had, perhaps, seen ‘Mrs McDougall at her worst, threatened as she was by the advent of the new course. But I did see how she functions under stress’. So Towle could not have recommended McDougall ‘for a stressful leadership post or to consent to work under her leadership’.76 Towle also made similar points to Caine.77 Following Titmuss’s return from the US he told Wilbur Cohen of the University of Michigan, soon to be a close friend, that he had found ‘not only a vast accumulation of paper but a serious academic crisis’.78 Shortly afterwards, he circulated a further memorandum to department staff on the new arrangements.The Applied Social Studies course would run the next academic year. Younghusband’s teaching contribution would terminate at end of present term, although it was to be hoped that she would take up a position on the Advisory Committee. Lewis had accepted an appointment for the next session to take charge of Applied Social Studies. McDougall would continue in charge of the Mental Health course, and would also be responsible for coordination of future policy. In the latter capacity, she would act as Executive Secretary of the Advisory Committee.All these arrangements were, though, provisional as, with ‘the cessation of the Carnegie grant, further developments will be dependent on many factors –​not least the availability of adequate funds in the next quinquennium to carry on professional social work education in the School’.79 However, the reputation of the department, and of the School, continued to take a battering. Cosse wrote to Younghusband in June 1957, praising her contribution to the Carnegie course. The LSE’s recent behaviour, though, ‘has not encouraged us to feel that they are the imaginative and forward looking body we thought them to

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be’.80 The following month, Lowe told Younghusband that he had recently written to Caine informing him that the last of the funding from the Trust ‘will be paid “with as much goodwill as possible in the circumstances”. I have rubbed in the expectation of the Trustees that the machinery for co-​operation with the professional bodies will be made to work so that the course may be a partnership in fact as well as theory’.81 The Trust, reviewing the experiment, noted in its 1958 Report that, as from academic year 1958–​59, the Applied Social Studies course had become ‘an established part of the School’s curriculum for training for social work’, and that its own financial support had now ceased. It also noted the imminent merger of the Child Care course and the Carnegie course, and, rather coyly, that there had been ‘inevitable changes in staff ’. BothYounghusband and Lewis were now no longer ‘actively concerned with the Course’.All who had contributed to the experiment’s success were to be congratulated. But Younghusband and Lewis, in particular, had made ‘distinctive and distinguished contributions in pioneering, sustaining and developing the Course and proving its value as a new form of education for social work’. Further evidence of the course’s success could be found in the establishment of similar programmes in other universities.82 Reflecting further on its experiment two years later, the Trust suggested that it had begun in 1954 with a ‘great deal of goodwill’, come through ‘many difficulties’, and made a ‘fundamental change in training for social work’. The ‘generic’ approach which it had utilised was ‘now standard practice’, and might ‘eventually lead to the unification of all specialist social work courses’.83 Titmuss, meanwhile, informed a Canadian colleague in autumn 1958 that, thanks to Donnison’s handling of the situation,‘things have settled down among the professional social workers’.84 In the longer term, the Carnegie experiment was, as Russell and her colleagues remarked, a ‘significant step towards the unification of social work training’. As noted, the Child Care course was amalgamated in the late 1950s, and in 1970 the Mental Health course came into the fold, creating the Diploma in Social Work Studies.85 In autumn 1958, an exchange took place between Titmuss and Younghusband which further attests to the complexity of their relationship.The context was his bout of tuberculosis, and the recent publication of Essays on ‘The Welfare State’. Younghusband told him that hearing of ‘your serious illness’ was ‘sad news’. Titmuss’s contribution to ‘social welfare policy’ was ‘unique, and must continue to be made, to the extent that your strength allows but not beyond it, as has happened in the past I fear’.Titmuss’s writing had ‘added a new dimension to this

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generation’s thought’.86 Titmuss thanked her for her letter, especially welcome given the volume of work undoubtedly involved in compiling her latest report. When the latter appeared, it was to be hoped that ‘it will be possible to set on foot some serious public discussion’. Titmuss himself was not ‘at all happy about the general trend of social work training’, and suggested Younghusband write a piece for The Times on the issue. He had already approached a friend –​presumably Lafitte again –​at the newspaper.87 Younghusband does not appear to have taken up Titmuss’s suggestion. But shortly after her report was published, Titmuss himself had an article in The Times. This praised Younghusband’s proposals as ‘practical, realistic and informed with a wealth of knowledge’ about the problems of individuals, and their families. But as to social workers, and as the report confirmed, the story had been one of ‘desperate shortages, pathetically low salaries, and the absence of in-​training and education schemes for the army of untrained workers’.88

Conclusion The irony of the Titmuss/​Younghusband dispute is that, essentially, they agreed on the future direction of social work training, Towle’s jibe notwithstanding. Nor is it helpful to focus exclusively on gender as the dispute’s underlying cause. Factors such as social class, and differences between British and American perceptions of social work, also played their part (Towle again did little to help in any of these respects). As to Titmuss himself, his handling of the dispute was, on occasion, clumsy, ill conceived, and lacking in decisiveness, although many heads of academic departments have found themselves in similar positions. But nor did Younghusband and her allies always behave in a collegial or conciliatory manner, with McDougall, for example, being a particular object of scorn. Titmuss almost certainly felt, too, that his energies might have been more usefully employed elsewhere, and his relief when the affair eventually ended is evident. Notes 1 Dahrendorf, A History, p 383; D. Donnison, ‘Taking Decisions in a University’, in D. Donnison,V. Chapman, M. Meacher, A. Sears, and K. Urwin (eds), Social Policy and Administration Revisited: Studies in the Development of Social Services at the Local Level, London, George Allen and Unwin, revised edn 1975. 2 A. Oakley,‘The History of Gendered Social Science: A Personal Narrative and Some Reflections on Method’, Women’s History Review, 24, 2, 2015, p 167. 3 EUGENICS, SA/​EUG/​C.333,‘The Family as a Social Institution’, nd, but 1953, pp  1–​3.

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‘We have our differences and do not always see eye to eye’ 4 TITMUSS7/​61, letter, 11 May 1953, Bishop of Sheffield to RMT. 5 BPP, House of Lords Hansard Sessional Papers, Fifth Series, Volume 182, cols 658–​66. 6 ‘Scope of the Health Visitor:  Inquiry Committee Chosen’, The Times, 29 September 1953, p 11. 7 RMT, British Journal of Sociology, 9, 3, 1958, pp 293–​5. 8 TITMUSS/​7/​60, letter, 5 March 1952, RMT to J. Harvard-​Watts, Routledge and Keegan Paul. This manuscript, entitled ‘Experiments in Training’, was probably an early version of M. Ashdown and S. Clement Brown, Social Service and Mental Health:  An Essay on Psychiatric Social Workers, London, Routledge and Kegan Paul, 1953. 9 H.L. Wilensky and C.N. Lebaux, Industrial Society and Social Welfare, New York, The Russell Sage Foundation, 1958, pp 332–​3. 10 The Calendar of the London School of Economics and Political Science, 1950–​51, London, LSE, 1950, pp 292–​9. 11 LSE/​Central Filing Registry/​514/​1/​K, RMT, four-​page memorandum, January 1959, ‘Department of Social Science and Administration’, pp 1–​3. 12 K. Russell, S. Benson, C. Farrell, H. Glennerster, D. Piachaud, and G. Plowman, Changing Course: A Follow-​Up Study of Students Taking the Certificate and Diploma in Social Administration at the London School of Economics, 1949–​1973, London, LSE, 1981, pp 1, 297, Appendix A. 13 R.M. Braithwaite, ‘Foreword’, in A.E. Hartshorn, Milestone in Education for Social Work: The Carnegie Experiment 1954–​1958, Dunfermline,The Carnegie United Kingdom Trust, 1982, p vii. 14 Russell et al, Changing Course, p 19. 15 A. Oakley, Women, Peace and Welfare: A Suppressed History of Social Reform, 1880–​ 1920, Bristol, Policy Press, 2018, ppn6–​7 and passim. 16 Donnison, ‘Taking Decisions’, p 260. 17 TITMUSS/​4/​599, Note, ‘Talk with F.  Lafitte and Miss Younghusband, 4th March 1952’. 18 Hartshorn, Milestone, pp 89–​90, 12–​13, 69. 19 TITMUSS/​4/​601, memorandum, May 1951, RMT to members of staff, Social Science Department, ‘An Institute of Applied Social Studies’. 20 Carnegie United Kingdom Trust: Forty-​Second Annual Report, 1955, Dunfermline, Carnegie United Kingdom Trust, 1956, p 46. 21 Hartshorn, Milestone, pp 91, 71. 22 K. Jones, EileenYounghusband: A Biography: Occasional Papers in Social Administration, no 76, London, Bedford Square Press, 1984, p 49. 23 TITMUSS/​4/​599, Memorandum, June 1952, RMT,‘Carnegie Trustees: Meeting with Sir Hector Hetherington, Mrs. K.  Elliot, James Wilkie, and Miss E. Younghusband’. 24 Hartshorn, Milestone, pp 69, 73, 92–​3. 25 TITMUSS/​4/​602, memorandum, 2 February 1954, Carr-​Saunders to RMT. 26 Jones, Eileen Younghusband, pp 56–​7. 27 TITMUSS/​4/​599, Memorandum, 1st December 1952, RMT to Carr-​Saunders. 28 Hartshorn, Milestone, pp 102–​3. 29 Ibid, pp 53–​4. 30 TITMUSS/​4/​601, letter, 22 July 1953, RMT to Younghusband. 31 TITMUSS/​4/​601, letter, 5 November 1953, RMT to Younghusband. 32 TITMUSS/​4/​601, letter, 24 October 1953,Younghusband to RMT.

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TITMUSS/​4/​601, letter, 11 November 1953, RMT to Younghusband. TITMUSS/​4/​601, letter, 22 November 1953,Younghusband to RMT. TITMUSS/​4/​601, letter, 3 December 1953, RMT to Younghusband. TITMUSS/​4/​601, letter, 8 December 1953,Younghusband to RMT. TITMUSS/​4/​601, letter, 16 December 1953, RMT to Younghusband. YOUNGHUSBAND, MSS.463/​EY/​P1178, letter, 12 January 1954, Roberts, Illinois, to Younghusband (emphasis in the original). 39 YOUNGHUSBAND, MSS.463/​EY/​P1244, letter, 16 December 1954, RMT to Younghusband. 40 YOUNGHUSBAND, MSS.463/​EY/​P1251, letter, 19 January 1955, RMT to Younghusband. 41 Donnison, ‘Taking Decisions’, p 263. 42 ‘Social Worker Scholarship Nullified Here’, The Washington Post, 5 September 1954, p M6. 43 Oakley, Women, Peace and Welfare, p 7. 44 Jones, Eileen Younghusband, p 59. 45 Donnison, ‘Taking Decisions’, pp 263, 254. 46 YOUNGHUSBAND, MSS.463/​EY/​P1260, letter, 6 May 1955, RMT to Younghusband. 47 YOUNGHUSBAND, MSS.463/​EY/​P1264, letter, 2 June 1955, RMT to Younghusband. 48 YOUNGHUSBAND, MSS.463/​EY/​P1268, letter, 9th June 1955, RMT to Younghusband. 49 Jones, Eileen Younghusband, pp 59–​60. 50 Hartshorn, Milestone, pp 107–​8. 51 Donnison, ‘Taking Decisions’, p 264. 52 Carnegie United Kingdom Trust: Forty-​Second Annual Report, 1955, Dunfermline, Carnegie United Kingdom Trust, 1956, p 47. 53 YOUNGHUSBAND, MSS.463/​EY/​P1288, letter, ? November 1955, Roberts to Younghusband (emphases in the original). 54 YOUNGHUSBAND, MSS.463/​EY/​P1297, letter, 18 January 1956, Towle to Younghusband. 55 Jones, Eileen Younghusband, pp 61–​2. 56 Donnison, ‘Taking Decisions’, p 264. 57 Oakley, Father and Daughter, p 136. 58 YOUNGHUSBAND, MSS.463/​EY/​P1315, memorandum, 8 June 1956, Younghusband to RMT. 59 Donnison, ‘Taking Decisions’, pp 266–​7. 60 YOUNGHUSBAND, MSS.463/​EY/​P1381,letter, 30 January 1957, RMT to Younghusband. 61 YOUNGHUSBAND, MSS.4.63/​E Y/​P 1385, letter, 31 January 1957, Younghusband to RMT. 62 YOUNGHUSBAND, MSS.463/​E Y/​P 1384, letter, 31 January 1957, Younghusband to Caine, and MSS.463/​EY/​P1387, letter, 1 February 1957, Caine to Younghusband. 63 Oakley, Father and Daughter, pp 136, 142. 64 YOUNGHUSBAND, MSS.463/​EY/​P1389, letter, 5 February 1957, Donnison to Younghusband (emphasis in the original). 65 YOUNGHUSBAND, MSS.463/​EY/​P1428, letter, 5 March 1957, Caine to Younghusband.

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‘We have our differences and do not always see eye to eye’ 66 YOUNGHUSBAND, MSS.463/​EY/​P1400, letter, 20 February 1957, RMT to Department Staff. 67 YOUNGHUSBAND, MSS.463, letter, 21 February 1957, Lowe to RMT. 68 YOUNGHUSBAND, MSS.463/​EY/​P1418, letter, 27 February 1957, Cosse to RMT. 69 YOUNGHUSBAND, MSS.463/​E Y/​P 2421, letter, 28 February 1957, P. Armstrong, Ipswich, to Kitty (?). 70 YOUNGHUSBAND, MSS.463/​EY/​P1426, letter, 4 March 1957, RMT to Armstrong. 71 YOUNGHUSBAND, MSS.643/​EY/​P1427, memorandum, 4 March 1957, RMT to Younghusband, and letter, 4 March 1957, RMT to Advisory Committee. 72 YOUNGHUSBAND, MSS.463/​EY/​P1435, letter, 11 March 1957,Younghusband to RMT. 73 TITMUSS/​7/​65, letter, 13 March 1957, RMT to Burns. 74 YOUNGHUSBAND, MSS.463/​EY/​P1441, letter, 14 March 1957, RMT to Younghusband. 75 YOUNGHUSBAND, MSS.463/​EY/​P1448, confidential memorandum, 18 March 1957, RMT to Younghusband. 76 YOUNGHUSBAND, MSS.463/​EY/​P1435, letter, 21 March 1957, Towle to RMT. 77 Oakley, Father and Daughter, p 140. 78 TITMUSS/​7/​65, letter, 7 June 1957, RMT to Cohen. 79 YOUNGHUSBAND, MSS.463/​EY/​P1505, memorandum, 12 June 1957, RMT to Department Staff. 80 YOUNGHUSBAND, MSS.463/​EY/​P1528, letter, 27 June 1957, Cosse to Younghusband. 81 YOUNGHUSBAND, MSS.463/​EY/​P1535, letter, 2 July 1957, Lowe to Younghusband. 82 Carnegie United Kingdom Trust:  Forty-​Fifth Annual Report, 1958, Dunfermline, Carnegie United Kingdom Trust, 1959, pp 33–​4. 83 Carnegie United Kingdom Trust: Forty-​Seventh Annual Report, 1960, Dunfermline, Carnegie United Kingdom Trust, 1961, p 45. 84 TITMUSS/​7/​66, letter, 3 October 1958, RMT to John S. Morgan, School of Social Work, University of Toronto. 85 Russell et al, Changing Course, p 19. 86 TITMUSS/​2/​154, letter, 4 November 1958,Younghusband to RMT. 87 TITMUSS/​2/​154, letter, 13 November 1958, RMT to Younghusband. 88 R.M. Titmuss, ‘Community Care as Challenge’, The Times, 12 May 1959, p 11.

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15 Essays on ‘The Welfare State’ and The Irresponsible Society Introduction By the late 1950s, Titmuss had laid the foundations, intellectually and institutionally, of the field of Social Administration. This involved not just academic research and publication, but also engagement with the policy making process. None of this was unproblematic.Titmuss’s work took place in the context of the Conservative Party’s political dominance, with some of its more dynamic members laying out plans for a shift from universal to selective social services.Within his own department,Titmuss had prevailed in his struggle with Eileen Younghusband, but the process had been exhausting and demoralising. As to research, Abel-​Smith was to record, in 1962, that the ‘funds channelled to us through the University are pathetically small and we can use them for little more than bibliographical research and pilot studies’ –​hence the need for external funding.1 More positively, this chapter examines the origins and impact of two of Titmuss’s most famous works, Essays on ‘The Welfare State’, and The Irresponsible Society.The latter, in particular, reveals much of his state of mind in the late 1950s, especially in the wake of the Conservatives’ 1959 election victory.

Essays on ‘The Welfare State’ Titmuss’s first collection, Essays on ‘The Welfare State’, appeared in 1958. A second edition came out five years later, and included The Irresponsible Society. A third, posthumous, edition was published in 1976, and in his introduction Abel-​Smith remarked that while the pieces were produced during Titmuss’s first decade at the LSE, ‘most of what he wrote then is still relevant to the study of social policy today’. Abel-​Smith further

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claimed that Titmuss had only accepted the volume’s title ‘after considerable persuasion from his publisher’, and that the expression ‘welfare state’ appeared in quotation marks ‘to make it clear that this was not his own description of Britain’s social services’. He also briefly summarised the book’s contents, asserting that ‘The Social Division of Welfare’ was ‘the most influential essay Titmuss ever wrote’.Winding up, Abel-​Smith reiterated the collection’s ongoing value,‘essential reading for the study of social administration’. While society and social needs certainly changed, it was important to ‘develop a deeper understanding of social need and social action’. In so doing, it was ‘critical to identify the really important questions’. Titmuss had ‘a remarkable ability to do so’, and that was what was ‘timeless about these essays’. A further edition, perhaps testament to this ‘timeless’ quality, appeared in 2018, with a useful commentary by Ben Jackson.2 But of what did the original collection consist? By Titmuss’s own account, its value was that it brought together pieces which students might otherwise find difficult to access, a problem drawn to his attention by ‘some of my friends responsible for the teaching of social administration’. No significant changes had been made to previously published pieces, for that would have involved ‘a complete recasting of the subjects discussed’, notwithstanding the temptation to do so in the light other authors’ works, for example Crosland’s The Future of Socialism. But all this served to underline that the ‘social services (however we define them) can no longer be considered “things apart”; as phenomena of marginal interest, like looking out of the window on a train journey. They are part of the journey itself. They are an integral part of industrialization’. Among those acknowledged for their support were Abel-​Smith, and Townsend.3 There are three components to the volume’s ten chapters. First, a group of six essays which had already appeared in print in one form or another, and a number of which have already been encountered, for example ‘The Social Division of Welfare’, and ‘Industrialization and the Family’ (Chapter  11).4 Second, there was ‘The Position of Women’, previously unpublished, also discussed in Chapter 11. Third, there were three pieces delivered as speeches during Titmuss’s 1957 American trip. Although dealing with the NHS, they were specifically tailored for their audiences, and thus will be dealt with in Chapter 21. In what follows we look at some responses to the collection as a means of assessing Titmuss’s standing by the late 1950s. For the most part, Titmuss was well served by, or lucky in, his reviewers.A journal hardly sympathetic to his worldview, The Spectator, nonetheless had the book reviewed by Townsend, recently appointed

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to Titmuss’s department. Altogether unsurprisingly, Townsend found the volume ‘a superb example of a rare kind of social analysis, in which particular social developments are rigorously documented and at the same time subjected to the searching tests of moral principle’.Townsend especially highlighted ‘The Social Division of Welfare’. For him, this was a ‘classic essay’, subsequently a widely shared view. Overall, Titmuss’s sympathies were plainly with those less well treated by society –​‘the poor, the sick, the unfavoured and those on the receiving end of autocratic professional behaviour’. Attention was also drawn to ‘the lessons of history and the importance of attending to the evidence, as well as repeatedly asking what are our social objectives’.5 Three other admirers were Norman MacKenzie, a left-​wing journalist and sociologist, Barbara Wootton, and Norman Birnbaum, a leading American sociologist and sometime LSE staff member. MacKenzie suggested that in ‘one example after another, Titmuss shows how we have wrapped social welfare in a cocoon of middle-​ class mythology’, so illustrating how our ‘whole social policy is riddled with … class assumptions’. In revealing such phenomena for what they really were, Titmuss’s ability was to ‘see such problems whole, and in a fresh light’. He was thus ‘the pioneer of a new social policy that has immense implications’.6 Wootton, meanwhile, found the book a ‘highly characteristic, as well as a highly valuable, example of its author’s special gifts’, these including the ‘mark of genius in the skill with which the author has extracted conclusions that others have missed from material which is readily available to all’. Like MacKenzie, Wootton noted Titmuss’s challenge to the ‘welfare state’, concluding that ‘by the time that Professor Titmuss has finished, the Welfare State begins to wear a sorry aspect’. Indeed, readers might find themselves surprised that he had even used the term, ‘even with the protection of inverted commas … since the existence of a welfare state seems itself to be one of the illusions which he has set out to destroy’.7 For Birnbaum, the collection showed the ‘distinctiveness and value of the British tradition in sociology’, while also being a ‘political event’. For instance, in his depiction of the NHS, Titmuss was ‘gently, but firmly, critical of the degree to which the [medical] profession controls the service’.Titmuss believed that a ‘public service ought to be controlled by the public’, an argument which would ‘give rise to some discussion’.8 Nor was the book’s impact confined to published reviews. In December 1958, P.K. O’Brien, chair of the Oxford Political Circle, invited Titmuss to give a talk on a subject of his choosing. But, O’Brien continued,‘your recently published book of essays has stimulated much discussion in Oxford and we should be very pleased if you could talk on

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some aspect of the Welfare State’.9 Hilary Rose, a future colleague, later recorded her engagement with the Universities and Left Review Club where, with others, she read ‘the current hit books’, with ‘everyone’ reading Essays on ‘The Welfare State’. This prompted Rose to enrol at the LSE in the ‘Titmuss department’, which was like being ‘let into heaven’. Although not uncritical of Titmuss, nonetheless to be ‘taught by someone whom you think can probably walk on water’ was ‘a special experience’.10 Of course, not all responses were positive. An anonymous notice in The Economist agreed that Titmuss had done the ‘welfare state’ a service by drawing attention to its undoubted shortcomings. The essays were insightful and stimulating, and ‘force the reader to reconsider his beliefs –​if not to renounce them’. One example was Titmuss’s analysis of the ‘new industrialism’, which ‘reduces man to a cipher and takes away his natural authority’. This was not only harmful in itself, but also to family life. On the other hand, some of the essays were already dated, for example that on pensions. More fundamentally,Titmuss had a tendency to find facts, ‘pounced on rather naively’, which supported a ‘preconceived theory, even if this means ignoring other facts that disprove it’. The ‘microscope Mr Titmuss uses in support of his intuition can be wonderfully illuminating, but he sometimes forgets that its field is limited.Were he to stand back occasionally and take a synoptic view, the service he has rendered to the welfare state could be greater still’.11 The volume was noticed in America too. In autumn 1959 John Gaus, an American political scientist, sent Titmuss a review by his Harvard colleague, John Kenneth Galbraith.12 This piece, with the punchy title ‘Them as has still gets’, was extremely positive. Galbraith claimed that the debate between liberals and conservatives over social security was unsatisfactory on both sides. But those who wanted ‘something much better –​competent on the larger issues and admirable as to detail –​ should read these lectures’ which showed how easily stereotypes arose in the field of social welfare. Galbraith, too, highlighted Titmuss’s analysis of fiscal and occupational welfare which demonstrated that the ‘welfare state and its associated attitudes are good for those at the bottom but far better for those at the top’. The essays were ‘a rich mine of information and ideas’. Although Titmuss wrote ‘easily and lucidly and with a kind of unvarnished elegance’, he wasted ‘no words on unnecessary explanation. He must be read with attention. But so read, he is worth the effort’.13 Although Galbraith’s waspish style was not entirely absent, this was still a glowing recommendation from one of America’s leading public intellectuals, and liberal thinkers. Titmuss was certainly gratified, asking Gaus that when he next encountered

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Galbraith he ‘tell him how much I value his appreciative review and how profoundly I and my younger colleagues have been influenced by his writings. In many subtle ways his ideas and approach to the study of contemporary social problems have helped shape our thinking’.14 This was an allusion to Galbraith’s ground-​breaking work, published in 1958, The Affluent Society, and Robert Pinker later recorded that Galbraith was one of the few economists Titmuss admired.15 More broadly, liberal thinkers such as Galbraith were an important influence on their left-​wing colleagues in post-​war Britain. Titmuss’s stock was high, in Britain and abroad, as the 1950s drew to a close. As we saw in Chapter 13, he was profiled in The Observer in 1959 as the ‘Welfare Professor’. In addition to commenting on Titmuss’s contribution to Labour’s pensions policy, this article suggested that while not as ‘extreme an egalitarian as, say, Lady Barbara Wootton’ Titmuss was, nonetheless, deeply concerned about ‘what may happen if the mass-​market consumption economy, copied from the United States, is superimposed on a profoundly class-​conscious society such as our own’. He was worried, too, about the ‘growing power of the large insurance companies’, and could see in Britain ‘a tendency towards “private affluence and public squalor” ’ (Galbraith’s famous phrase).16 As a lead-​in to Titmuss’s next major publication, this could hardly be bettered.

The Irresponsible Society: the context In November 1959 Titmuss gave a speech to a Fabian audience which, after revision and retitling, was published the following April as The Irresponsible Society, a work which had an immediate impact, going on to be one of the pieces by which he continues to be judged. Consequently, its origins and arguments are considered in some detail. The timing is crucial, for Titmuss’s lecture came only weeks after the 1959 general election, easily won by the Conservatives on the back of the claim that the British people had ‘never had it so good’. Defeat prompted considerable soul-​searching within the Labour Party. It was clear, for example, that many trades unionists, supposedly the party’s working class base, had voted Conservative. Given his role in Labour’s social policy formation, all this must have been galling for Titmuss as Labour’s 1959 election manifesto was, by David Edgerton’s account, ‘the most welfarist … ever’.17 Divisions within Labour were especially exemplified by the acrimonious conference in late 1959 at which Gaitskell unsuccessfully sought to initiate a process of ‘modernisation’ through, in the first

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instance, a rejection of the totemic Clause Four of the party constitution which proposed nationalisation as the way forward for the achievement of socialism. Gaitskell’s defeat can be seen as a victory of ‘traditionalist’ Labour movement views over those of the ‘revisionists’, such as Crosland, who sought to bring the Labour Party more into line with trends and aspirations within contemporary society, and so embracing ‘The Affluent Society’.18 But the latter had its critics, and Stuart Middleton identifies three interrelated strands in some Labour members’ opposition to ‘affluence’: a moral critique of consumption, the unwelcome dominance of private over public interests, and an egalitarian critique of post-​war capitalism in which the word ‘affluence’ actually concealed ‘persistent poverty and inequality’.The task of politics, then, was not just to be responsive to social conditions, but rather to rebuild society on ‘more rational and moral lines’.19 Titmuss would have bought into nearly all of this. There was, then, a febrile debate taking place within the British left about means and ends, to which Titmuss was to contribute. A further aspect of the broader context is what Rodney Lowe described as a ‘reappraisal of welfare policy’. This had started in 1955 with the setting up of a ministerial Social Services Committee by the Treasury. The Treasury was, as always, concerned about the level of welfare expenditure, and hoped that the committee would provide a platform for retrenchment. In fact, this ploy rebounded, with wide-​scale cuts being rejected while, as we have seen, the Guillebaud Committee stymied Treasury plans by suggesting the need for more health expenditure. As Lowe suggests, at least as far as the Conservative Party and the Treasury were concerned, this was a missed opportunity to reform social welfare.That the challenges facing politicians and the Civil Service were evaded at this point, Lowe concludes, meant that henceforth it was not ‘the construction but the destruction of the welfare state that was … to become the object of “conviction” politics’. As witness to this, he cites the creation of a body soon to engage head-​on with Titmuss, the Institute of Economic Affairs.20 Lowe also located these developments within ‘The Affluent Society’. This involved rising living standards and full employment in an expanding economy. Consequently, members of the working class, particularly, were able to consume goods and services previously outside their grasp. Affluence was important because it changed public expectations of welfare provision –​essentially, people expected more and better –​and provided the money to do so. More than this, affluence ‘afforded society the luxury of redefining poverty’, and Lowe makes a convincing case that both the Conservative Party and bodies charged

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with implementing social policy had accepted the concept of ‘relative poverty’ ahead of the work on the subject by Abel-​Smith and Townsend. Leading Conservatives also agreed that, in certain circumstances, the state could deliver better services than the free market.21 Problems were going to arise, though, if economic growth stalled. Social policy was thus at the heart of political debates as Britain entered the 1960s. But at least in the late 1950s, pragmatism on Conservative government’s part stood it in good electoral stead. More should be said, too, about the IEA, founded in 1955, and with links to an international network seeking to promote free market ideas. Its leading members were Ralph Harris and Arthur Seldon. Central to their approach was, Ben Jackson argues, that ‘the advancement of freedom was … synonymous with widening individual choice, which was construed as independent of whether individuals possessed sufficient economic resources to exercise that choice’. In the first instance, the IEA focused on the ‘welfare state’, seeing in its shortcomings the paternalistic state’s failure as a monopoly provider. Rather than becoming dependent on the state, individuals should be encouraged to be independent. In one of its publications, authored by Seldon, a contrast was made between Titmuss’s notion of universal welfare provision as a form of social citizenship, and the more desirable notion of independent self-​reliance. This was not to say that there was no place for state support. Rather, there should be, for those in greatest need, residual social services. As we shall see in Chapter 27, the IEA loudly and litigiously proclaimed its independence from any political party. Nonetheless, its ideas appealed to certain strands in the Conservative Party because ‘it articulated, in a more sophisticated and social-​scientific form, ideas that were already present in the party’s political thought’. Here we might recall Enoch Powell and Iain Macleod’s concerns in the early 1950s over universalist welfare, and among those influenced by IEA ideas were Powell, and fellow members of the party’s One Nation Group.22 The Group engaged with contemporary issues from an ‘advanced’ position, that is one which did not dismiss out of hand features of modern life such as the ‘welfare state’. Its name hearkened back to Disraeli’s ‘one nation’ Toryism, and it was driven forward by younger Conservatives anxious to move their party away from its more reactionary elements. In March 1959 it produced The Responsible Society.This pamphlet had, as Robert Walsha demonstrates, a long and complicated early history, not least because of problems in finding common ground among contributors. For present purposes we focus primarily on what Walsha describes as the ‘centrepiece chapter’, that by Sir Keith Joseph on the social services.23

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The social services were, Joseph acknowledged, a ‘permanent feature of national life’, albeit subject to varying interpretations. At one extreme was the view that ‘their automatic provision is held to corrupt the citizen’s self-​reliance, demoralise family and religious life, and magnify the Government’.The diametrically opposite standpoint was that ‘the Welfare State is seen as an instrument of egalitarian social policy’. There was a range of intermediary positions, but what all, except the advocates of ‘egalitarian social policy’, agreed was that ‘the social services tend to make people irresponsible’. Among the underlying principles Joseph thus sought to establish was that any individual, or any organisation, in receipt of monies from the state should have restraints imposed upon their liberty. This was not an argument against official aid in any form. Rather, it was an argument for ‘keeping the balance ever in mind: and for being predisposed (as most Socialists are not) to let the individual pay and act for himself when he can’. A further problem with state disbursements was that they increased the power of those doing the disbursing. The over-​centralisation of ‘any service, particularly social services’ was thus ‘not an imaginary evil’.A discussion on funding followed, with a strong bias away from taxation, towards insurance. Joseph concluded that it was too early to say what effect the social services had had on ‘the character of our people’. But, if ‘the services tend to be paid for by contribution and are only one part of the pattern of personal, family, voluntary and public help available to the citizen’, then the responsible society was not in danger. Social services must, therefore, ‘encourage each person to provide for himself and his family over and above the national minimum’.Thrift remained a virtue, and should be duly rewarded. Given all this, the social services would ‘enlarge the freedom and security of the citizen. Such freedom and such security are the basis of a responsible society –​and not its enemy’.24 Joseph was thus arguing for fundamental welfare reform, the Conservative government’s pragmatism notwithstanding.

The Irresponsible Society: the speech, the pamphlet, and the reaction Against this background, how did Titmuss come to make his speech in November 1959? Six months earlier,Townsend wrote giving advance notice of the Fabian Society’s programme for its autumn lecture series. He reported that ‘Tony Wedgwood Benn has been very anxious to see if we could ask you to give one lecture’, and that he and Benn had been ‘trying to make [the series] as impressive and forward looking as possible’. Consequently, they had reduced ‘the hack politician

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representation’. The aim was to get away from ‘day to day issues’, and ‘by seeking speakers who would themselves play a large role in influencing the development of opinion on policy, attract and interest many intelligent people on the left anxious to learn about fundamentals’.25 Titmuss was duly invited to contribute to ‘Socialism in the Sixties’, with his particular brief being ‘What Sort of Society?’26 Titmuss accepted, remarking that although he had ‘a lot of other things to do I have been persuaded that this is important’, presumably by Townsend. He also enquired whether the lecture would be published, as this ‘does make a difference when one is preparing it’.27 The press release advertising Titmuss’s lecture, entitled ‘Social Policy and the Responsible Society’, noted his contribution to Labour’s policy formation, and outlined the talk’s main themes.These included unpicking the notion of post-​war consensus, an idea which avoided ‘awkward questions’ about social and economic power, and contemporary ‘disenchantment with democracy’. The latter had especially affected young people, partly because of the professionalisation of education, especially higher education. The ‘folklore of the welfare state’ was then to be discussed, including the ‘connections between social policy, fiscal policy and the distribution of economic and social power in society. Here it is that inequality has a dynamic of its own’. Among the concentrations of economic power to be highlighted were the insurance companies. Financial and ‘self-​regarding professional power’ were thus ‘accelerators of inequality’. All this was the ‘mark of an irresponsible society’.28 The lecture was clearly intended as a riposte to the One Nation Group’s publication. The event itself was well attended and successful. Bill Rodgers, Fabian Society General Secretary and later Labour Minister, wrote to Titmuss in early February 1960. Rodgers acknowledged the receipt of his draft pamphlet, adding that ‘I barely heard your lecture because I was trying to control the people who could not get in, but now I know why all those who succeeded were so enthusiastic. It is a tremendous indictment’.29 Crossman was equally enthusiastic, recalling, at Titmuss’s memorial service, that the lecture was ‘One of the finest … I heard him give’.30 It is not clear when Titmuss altered the title of his lecture, although the revision is alluded to in the press release, but by the time of the pamphlet’s publication it was as The Irresponsible Society. A press conference was held in late March 1960.The Fabian Society was keen that Titmuss’s publication receive as much publicity as possible, inviting a large number of journalists, politicians, and academics to the event. Titmuss himself, suffering from dysentery picked up in Mauritius, was unable to attend.The meeting was chaired by Gaitskell, with Townsend

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answering questions on Titmuss’s behalf. Titmuss, in a letter of thanks to Gaitskell, remarked that ‘if the reports that have reached me are correct I am sure I should have been deeply embarrassed had I been there’.31 It is difficult to know if this is genuine, or false, modesty, but the pamphlet certainly caused a stir. Rodgers told Titmuss that following the launch there had been a leader in The Guardian, and a ‘large piece in The Times’.32 Shirley Williams later recalled that when she took over as Fabian Society General Secretary in 1960, the subject which preoccupied the organisation during her four years in charge was ‘the construction of the welfare state’. Titmuss had presided over a series of pamphlets on the topic ‘to which his younger colleagues, Brian Abel-​Smith and Peter Townsend, made distinguished contributions’.33 The Irresponsible Society started this particular ball rolling, and over the coming years the trio were to produce 11 Fabian Tracts. So what did The Irresponsible Society have to say? It started with the challenging statement that one of the most ‘important task of socialists in the 1960s will be to re-​define and restate the inherent illogicalities and contradictions in the managerial capitalist system as it is developing within the social structure of contemporary Britain’. Of particular importance, and here Titmuss cited Tawney and Crossman in support, were the ‘changing concentrations of economic and financial power’. It was the insurance companies especially that bore the brunt of his attack, not least because social policy was being tailored to suit their interests. A  contemporary instance of this was the 1959 National Insurance Act which had been ‘deliberately framed to encourage the further growth of private insurance power’. This constituted a ‘major shift in economic power in our society’ which, in turn, was leading to greater centralisation of power in general.The notion that the ‘welfare state’ had solved all social problems, meanwhile, was a ‘myth’. So, and quoting Townsend’s recent work, it might be that up to 8 million people were experiencing poverty, many them old, disabled, or handicapped. There was more along similar lines, with Titmuss deploying an array of empirical evidence to bolster his case.34 The most striking part of the pamphlet deals with social values, and the aims of social policy, and can only be seen as a cry of rage and frustration about contemporary society, particularly given the recent general election result. Titmuss suggested that underlying prognoses of continued economic growth was the assumption of a smaller role for government. He cited Galbraith’s The Affluent Society to the effect that public services were increasingly seen as an ‘unnecessary, doctrinaire burden on private enterprise’. It thus became harder to make positive political decisions ‘about equality and its correlate freedom’,

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as the majority of voters financially prospered. These voters assumed, wrongly, that an expanding economy would ‘automatically solve the problems of the poverty of dependency, the slums of obsolescence, the growth of irresponsible power and all the contradictions that flow from undirected or misdirected social policies’.35 Modern social trends, moreover, encouraged the ‘growth of conformism unless checked by strong, continuing and effective movements of protest and criticism’. Otherwise democracy was threatened. British society had come a long way since the 1930s, but Titmuss questioned how much ‘moral progress’ had been made. In his youth, arguments had taken place about enhancing democracy and improving social conditions, and so ‘We believed in the possibility of an alternative government’. What he and his associates had not realised was that ‘government by the people could mean that power in government, the Cabinet and the City, could lie almost permanently in the hands of those educated at Eton and other public schools’. Nowadays, though, youthful rebellion was ‘less concerned with political and democratic ideas’, although this was not entirely young people’s fault, for what was society offering apart from material success? So what was required was moral leadership to address problems such as global inequalities and racial intolerance. It was the duty of those in positions of power and authority to offer such leadership, but here the 1950s had shown little progress. Nor was it solely the Labour Party’s responsibility to address these issues. To enhance democracy ‘through education, by breaking down the barriers of social discrimination in all our public services, and by civilising not only Government but the great private bureaucracies and professional associations whose decisions so vitally affect our lives’, was the responsibility, too, of those currently holding political power.36 Titmuss was not, however, optimistic about this happening under the present administration. He cited a recent book by the Conservative peer Lord Hailsham, one passage of which had contrasted Tories with ‘Communists, Socialists, Nazis, Fascists, Social Creditors, and most members of the British Labour Party’. The latter, unlike the former, ‘believed that political struggle is the most important thing in life’. Titmuss clearly took considerable exception to this, claiming that such a statement would have been ‘unthinkable in the context of 1940 or 1945’ (a rather naïve remark, given some of the political rhetoric of the 1940s). And yet, Titmuss incredulously noted, Hailsham had recently been elected rector of Glasgow University by a large student majority. Taking an overall view, and particularly the pursuit of affluence rather than tackling inequality, Britain thus bore ‘simply the mark of an irresponsible society’.37

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What are we to make of this? Four points stand out. First, prior to publication Titmuss sent a draft out for review.Townsend had little to say beyond that the ‘analysis is magnificent and could scarcely be bettered. As a published lecture it will have a lasting effect’.38 Abel-​Smith, though, offered a more detailed critique, running to three typescript pages. A  key criticism addressed Titmuss’s obsession with insurance companies. Their role, Abel-​Smith suggested, was not necessarily ‘an undesirable development’. The companies’ unwillingness to invest in, say, South Wales was ‘not a point against insurance companies but rather a point against private enterprise as a whole’. Nor was it possible to see how such organisations could direct other companies to invest in declining areas. Abel-​Smith agreed that the ‘location of industry needs to be controlled’. But the fundamental issue was ‘against unfettered private enterprise rather than a case against the control or possible control of manufacturing industry by insurance companies’. Abel-​Smith even went so far as to suggest, no doubt to Titmuss’s annoyance, that in a private enterprise system large holdings by insurance companies could serve the national interest. This derived from their power to influence, in terms of economic efficiency, those companies in which their investments were held.39 It has been suggested that Abel-​Smith saw part of his role as ‘tutoring’Titmuss in economics, and perhaps that is what is going on here.40 As we have seen, Titmuss largely ignored these comments, which were nonetheless well made points. Second, not everyone, even on the political left, necessarily bought the whole package.The article in The Guardian, alluded to by Rodgers, was especially revealing. Under the heading ‘Irresponsible Society’ it noted Titmuss’s role in ‘social thinking on the Left’, and in policy planning. His pamphlet was ‘certain to attract wide attention if only because of its sustained attack on the concentration of power in the hands of private insurance interests’. This was, though, only an introduction to its ‘wider theme’, namely that ‘the critical decisions about social policy are increasingly taken in the private committee-​rooms of industrial and financial bureaucracy while the Government steadily relinquishes control’. However, Titmuss’s ‘austere view of society, and the stark egalitarianism implied in his analysis, may not be accepted by everyone, even in the Labour Party’. Nonetheless, the insistence that ‘rising incomes do not automatically remedy all social problems’ deserved attention, as did ‘his challenge to the politicians to apply their “social inventiveness” to seeking new ways of tackling changing social needs’.41 Although generally positive, can we detect a hint of criticism in the use of the word ‘austere’ given that rationing, a prominent characteristic of post-​war society, had finally ended only five years

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previously? And austerity was certainly not what Labour revisionists such as Crosland envisaged as the key to the future or, more immediately, to electoral success. Perhaps it was this which, by John Vaizey’s account, caused Crosland to accuse Titmuss, in 1961, of being a ‘crap merchant’. Vaizey suggests, too, that Crosland was no fan of ‘cloudy eloquence’.42 Differences within the political left about affluence are important, and worth further brief exploration. To do so we look at a speech by Crosland, another attempt to address what Labour should do in the wake of its 1959 defeat. Crosland started out with ten propositions, ‘basic Socialist values’, to which all democratic socialists should subscribe. These included support for an ‘increase in the rate of economic growth, both for the sake of a higher standard of living and as a pre-​condition of achieving other objectives’ –​for Titmuss, a dubious proposition. In passage headed ‘Attitude to Affluence’, Crosland argued that Labour must ‘rid itself of the image of being pro-​austerity and anti-​prosperity’.This was partly a hangover from the post-​war era, and should eventually disappear. Nonetheless, it was ‘constantly being refurbished by Labour speakers, and notably by those moralists in the Party who repeatedly condemn the whole affluent society as rotten and evil’. Such individuals failed to ‘distinguish the fact of affluence, which is to be welcomed since it widens the range of choice and opportunity open to the average family’, and certain avoidable characteristics such as the neglect of social spending. Confusing ‘the whole with the part’ created, to the Conservatives’ advantage,‘a most harmful impression of hostility to economic progress’. Nor was it the case that affluence was a house built on sand, although Crosland acknowledged, for example, that Britain’s economic performance was poor by international standards.Yet ‘the fact that prosperity could be greater does not make it any the less real; and to be always nagging at it is to give the impression of disliking and resenting it’.43 Crosland’s jibe about ‘moralists in the Party’ surely had Titmuss in its sights. Middleton notes that Crosland returned to this issue later in 1960, decrying those ‘fundamentalists’ who condemned the affluent society as ‘irresponsible’.44 Again, surely, a barbed attack on Titmuss. The third point about the response to The Irresponsible Society is that the political right went on the attack. The Spectator, in a piece headed ‘Selective Irresponsibility’, suggested that Titmuss was the Labour Party’s Condorcet, and expressed relief that the pamphlet had not been entitled The Glittering Coffin.45 The Marquis de Condorcet was an eighteenth century French philosophe who believed in mankind’s perfectibility, not something to which The Spectator would subscribe. The Glittering Coffin was the title of the first book by Dennis Potter,

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Labour Party member, writer, and later famous playwright. It was a ‘state of the nation’ polemic, citing work by, among others, Townsend and Abel-​Smith. Potter’s ‘Postscript’ dealt with the outcome of the 1959 election, and urged the need to confront ‘this twisted, acquisitive and essentially hollow society of ours’, sentiments to which Titmuss would have signed up. It is equally clear that The Spectator was not impressed.46 But, as Richard Jobson shows, Potter’s book was ‘widely discussed’ in Labour Party circles in the early 1960s. It dealt both with the need for the party to modernise, while engaging in a form of nostalgia about the purported glories, and solidarities, of the labour movement’s past. As such, it was an ‘example of the level of internal turmoil and conflict that a nostalgic understanding of the past could exact on a party member in early 1960’.47 Can we discern tensions in Titmuss’s work between the need for social advance, and a romanticised view of the past? There are more than hints of this in The Irresponsible Society. In any event, The Spectator conceded that Titmuss’s analysis of the actual nature, and consequences, of contemporary social services, and the ‘myth’ of the welfare state, was ‘compelling’.The rest was much less convincing though. Insurance companies were his particular ‘bugbear’, with all society’s ills being laid ‘at the door of the Prudential’. Titmuss had, purportedly, also identified other worrying trends in society, for example that the Institute of Directors had ‘produced an irresponsible society and are daily making it still more irresponsible’. By such an account, ‘social selfishness and irresponsibility are on the increase and their results are harmful’. But Titmuss had ‘calmly omitted’ mentioning ‘probably the most irresponsible and selfish group in the community –​the trade unions’. While he railed against ‘callousness and cowardice’ on the government’s part in addressing problems which were in its domain, he had nothing to say about the TUC’s failure to curb ‘wildcat strikes’. This was a ‘sad refusal’ to address ‘one of the greatest strongholds of irresponsibility that we face’. As to Titmuss’s argument that it was socialists who held the key to resistance to ‘conformism’, this was simply nonsense.48 Whatever this review’s analytical merits, it was an astute piece of journalism. It played to widespread concerns about unofficial, or ‘wildcat’, strikes, a problem which was to be unsuccessfully addressed by the post-​1964 Labour governments. It hit its target in the sense that Titmuss’s hostility to corporate interests did not, in public at least, extend to organised labour. The article was thus clever in implying, without actually using the word, that he was a hypocrite. Fourth,Titmuss came in for some academic criticism, criticism which arguably laid bare some of the underlying weaknesses of his approach. Notable here was that of his LSE colleague, the political scientist

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Bernard Crick. Reviewing the ‘socialist literature’ of the 1950s, Crick argued that there was an intellectual vacuum in left-​wing thought, and no clear sense of direction. Consequently ‘new theory’ was as yet ‘inchoate, implied, immanent rather than actual’. Even the recent appearance of Titmuss’s Essays on ‘The Welfare State’, and the ‘already influential’ The Irresponsible Society, were no reason to alter his argument.Titmuss had certainly stimulated interest ‘in the sociology of the “Welfare State” ’, while his ‘very strength’ was his ‘refusal to generalise’. The ‘strongest general point’ in The Irresponsible Society was, essentially, a ‘condemnation of a “retreat from government” ’. Nobody could read Titmuss without feeling that underlying the ‘very humanistic warmth and clarity of his style’ there was ‘a general theory of social planning struggling for emergence’. In a quietly damning conclusion to this passage, Crick suggested that such a theory had ‘not yet emerged –​ and the suppression may even be deliberate’. In another passage, Crick deprecated the ‘Fabian vice of mere exposure’, that is, the accumulating of ‘facts’ which were then held to speak for themselves. This too is a charge which could, on occasion, be laid at Titmuss’s door, although in this particular piece it was Abel-​Smith who came close to committing this heinous crime.49 As always with this sort of criticism, it is not necessary to agree with all of it to acknowledge that powerful points are being made. Finally in this section, a further sense of Titmuss’s thinking by the late 1950s can be gained from correspondence with Julian Huxley.As early plans for Titmuss’s Fabian lecture were being laid, Huxley invited him to contribute a chapter on ‘Social Services’ to a book he was editing on humanism. Huxley outlined the aim of his volume and, in an attached memorandum, suggested that ‘social science in a humanist frame needs considerable rethinking’. For instance, the phrase ‘Fulfilment Society’ might replace ‘The Welfare State’ as a ‘key concept or slogan for the next phase of social development’. Such a ‘Fulfilment Society’ would seek not only to provide educational and labour market skills, but also ‘enlarged comprehension of life, adventure, participation in worthwhile projects, research, meditation and inner development, recreation, creative activity, aesthetic enjoyment, significant rituals, etc’.50 Titmuss replied that, because of his current treatment for tuberculosis, he was declining the invitation. But he had been very attracted because ‘I happen to agree very strongly with the general ideas you express in your memorandum’.51

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The Irresponsible Society: the aftermath Titmuss was directly contributing to contemporary debates about the nature of modern society, and some of his ideas made their way into the 1961 Labour Party publication Signposts for the Sixties.52 He was far from alone in thinking that conformism, and lack of individuality, a sort of ‘deadening’ of society, was an unwelcome by-​product of affluence. Such conformism also threatened democracy, which was in further danger of being replaced by corporate power. Economic growth on its own was not sufficient for the promotion of a fair society. Indeed, it was producing further and greater inequalities.The journal New Society was founded in 1962 as a platform for social commentary. A year into its existence, it could claim that what the increasingly confident social sciences had shown was that ‘affluence is not enough’.53 And it is not unreasonable to see Titmuss’s interventions as part of the broader assault on ‘The Establishment’ so characteristic of the late 1950s and 1960s. If Titmuss was not a satirist or an angry young man, he was a pretty annoyed middle-​aged one. The notion of the ‘irresponsible society’ became part of the left-​liberal vocabulary. In summer 1960, the Fabian Society told Titmuss that the American organisation the League for Industrial Democracy,‘which in some respects is similar to the Fabian Society’, was seeking permission to reproduce The Irresponsible Society, and this was eventually agreed.54 A letter from Townsend to The Listener in October 1960 took Arthur Seldon to task for misrepresenting his (Townsend’s) statistical data on poverty. It was headed ‘The Irresponsible Society’.55Yet, unsurprisingly, it was Titmuss himself who most actively promoted the argument. For instance, in July 1960 he gave a 20-​minute radio talk (for which he received 30 guineas) on the ‘Irresponsible Society’ for the BBC’s Third Programme.56 The undated notes for a lecture, again with the same title, at Imperial College in London suggested that only a few of the ‘moral aspects’ of ‘The Affluent Society’ had been touched upon, before concluding that it had been shown that ‘the growth of new concentrations of economic power can lead to irresponsible decisions and to the neglect of social problems’.57 In October 1962, two and a half years after the pamphlet’s publication, the London District of the Workers’ Educational Association (WEA) organised a course of public lectures at the LSE under the rubric ‘The Irresponsible Society’. In addition to Titmuss, four other speakers were engaged –​Barbara Wootton, the industrial relations academic Allan Flanders, the recently ennobled socialist journalist Lord Francis-​Williams, and the Shadow Foreign Secretary, and soon to be

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Labour leader, Harold Wilson.58 Titmuss started his contribution,‘The Irresponsible Society: A Re-​Assessment’, by praising the WEA for its ongoing commitment to ‘the advancement of liberal studies’.This was no easy task when ‘so much of the spirit of the age is given over to the pursuit of materialism’. His views had not changed much since his original talk, and rather than recapitulate he would concentrate on particular issues. Following the general premises of his earlier speech, Titmuss denounced criticisms of the ‘welfare state’ from employers, employers’ organisations, members of the judiciary, members of the clergy, and professional bodies. In none of this commentary ‘can one find a sense of pride or achievement’.The British, in creating the NHS, ‘had made a contribution to civilized living’, but this went unrecognised and, indeed, the service was ‘spoken of almost with a sense of shame, a symbol of softness which had led, among other things, to the loss of Empire’. The social services were, in now familiar terms, not only a means of redistributing wealth but were also increasingly concerned with the ‘quality of civilised living, with the condition of the physical environment, with our attitudes and values towards minority groups, the deprived and the poor, and with the diffusion of power and the multiplication of loyalties’.59 What also marks out this speech is that Titmuss addressed two important contemporary issues: race relations and Britain’s membership of the European Union’s predecessor, the European Economic Community. These were topics on which Titmuss had pronounced views, and this speech is returned to in Chapter 26. But here it is worth noting his praise for the WEA. This was a voluntary organisation in which his intellectual mentor, Tawney, had played a considerable part. As Lawrence Goldman notes, Tawney was moderately keen on state intervention in industry, though ‘less enthusiastic when it came to civil society: here he remained a voluntarist in the idealist tradition he had learned at Balliol’.60 Titmuss did not derive all his ideas undigested from Tawney. Nonetheless, given how often he is criticised for his neglect of the voluntary sector, Titmuss’s complimentary remarks about one such body, whose independence was fiercely supported by Tawney, is notable. And Titmuss reiterated his support for voluntarism on a number of occasions. He told a conference in 1964, for instance, that in offering his congratulations to the National Old People’s Welfare Council he would not be, he hoped, ‘accused of undue bias in favour of voluntary organisations’. It could no longer be said that as it often was ‘a few years ago, that voluntary organizations tend to live, philosophically and intellectually, in a distant romantic age of spontaneous, leaderless, unplanned self-​help’. Titmuss then went on to stress the

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need for voluntary, and public sector, community workers to operate together in an integrated, coordinated manner.61 A strong voluntary sector could contribute positively to a responsible society.

Conclusion Ben Jackson suggests that, while much has undoubtedly changed since Essays on ‘The Welfare State’ was first published,Titmuss raised questions which help promote the idea that the ‘welfare state’ remains the ‘principal means of advancing the ethical commitments of equality and solidarity he held dear’.62 The persistence, and relevance, of Titmuss’s ideas is addressed in Chapter 30. Essays on ‘The Welfare State’ and The Irresponsible Society certainly made a contemporary impact, and are crucial to our understanding of Titmuss’s ideas as his first decade at the LSE came to an end. Of course, he had articulated many of his beliefs and arguments before. But these two publications were more accessible than, say, his jointly authored volume on the cost of the NHS, or his dense and closely argued pieces on pensions. If they made an impact, they did so by design, not accident. As always,Titmuss was keen to get his message out to as wide an audience as possible. They also set an agenda for the 1960s, arguably the era of Titmuss’s greatest influence, and the subject of this volume’s next part. Notes 1 B. Abel-​Smith, ‘Research Report no 4: Department of Social Administration, London School of Economics and Political Science’, Sociological Review, 10, 3, 1962, p 329. 2 R.M. Titmuss, Essays on ‘The Welfare State’, London, London, Allen and Unwin, 1958; Essays on ‘The Welfare State’, London, Unwin University Books, 2nd edn 1963; B. Abel-​Smith,‘Introduction’, in R.M.Titmuss, Essays on ‘The Welfare State’, London, George Allen and Unwin, 3rd edn 1976; R.M. Titmuss, Essays on ‘The Welfare State’, Bristol, Policy Press, 2018. 3 R.M.Titmuss,‘Preface’, in Essays on ‘The Welfare State, London, George Allen and Unwin, 1958. 4 The others in this group are ‘War and Social Policy’ (discussed in Chapter 7), ‘Social Administration in a Changing Society’ (Chapter  10), ‘The Hospital and Its Patients’, (Chapter 12), and ‘Pension Systems and Population Change’ (Chapter 13). 5 P. Townsend, ‘Welfare Myths’, The Spectator, 12 September 1958, p 349. 6 N. MacKenzie, ‘The Double Standard’, New Statesman, 13 September 1958, pp  355–​6. 7 B. Wootton, British Journal of Sociology, 10, 2, 1959, pp 156–​8. 8 Anon (but N. Birnbaum),‘Social Forces’, The Times Literary Supplement, 3 October 1958, p 565. 9 TITMUSS/​7/​69, letter, 31 December 1958 O’Brien to RMT.

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Essays on ‘The Welfare State’ and The Irresponsible Society 10 H. Rose, ‘An Accidental Academic’, in M.  David and D.  Woodward (ed), Negotiating the Glass Ceiling: Careers of Senior Women in the Academic World, London, The Falmer Press, 1998, pp 106–​7. 11 Anon, ‘Spotlight on Shortcomings’, The Economist, 6 December 1958, p 886. 12 TITMUSS/​7/​67, letter, 18 September 1959, Gaus to RMT. 13 J.K. Galbraith,‘Them as has still gets’, The Reporter, 17 September 1959, pp 60–​62. 14 TITMUSS/​7/​67, letter, 28 September 1959, RMT to Gaus. 15 R. Pinker, ‘Richard Titmuss and the Making of British Social Policy Studies after the Second World War: A Reappraisal’, in J. Offer and R. Pinker (ed), Social Policy and Welfare Pluralism: Selected Writings of Robert Pinker, Bristol, Policy Press, 2017, p 101. 16 ‘Welfare Professor’, The Observer, 22 March 1959, p 13. 17 D. Edgerton, The Fall and Rise of the British Nation: A Twentieth Century History, London, Allen Lane, 2018, p 371. 18 P.M.Williams, Hugh Gaitskell, Oxford, Oxford University Press, new and abridged edn, 1982, Ch 19. 19 S. Middleton,‘ “Affluence” and the Left in Britain, c 1958–​1974’, English Historical Review, 129, 536, 2014, p 109. 20 R. Lowe, ‘The Replanning of the Welfare State, 1957–​1964’, in M. Francis and I. Zweiniger-B ​ argielowska (eds), The Conservatives and British Society, 1880–​1990, Cardiff, University of Wales Press, 1996, p 255; and R. Lowe, ‘Resignation at the Treasury: The Social Services Committee and the Failure to Reform the Welfare State, 1955–​57’, Journal of Social Policy, 18, 4, 1989, pp 523–​4, 525. 21 R. Lowe, ‘Modernizing Britain’s Welfare State:  The Influence of Affluence, 1957–​1964’, in L. Black and H. Pemberton (eds), An Affluent Society? Britain’s Post-​War ‘Golden Age’ Revisited, Aldershot, Ashgate, 2004, pp 38, 44, 46, 47. 22 B. Jackson,‘Currents of Neo-​Liberalism: British Political Ideologies and the New Right, c 1955–​1979’, English Historical Review, 131, 151, 2016, pp 832–​3, 834–​5, 835, n 45, 837. 23 R.Walsha,‘The One Nation Group and One Nation Conservatism’, Contemporary British History, 17, 2, 2003, pp 87–​8. 24 K. Joseph, ‘The Social Services’, in One Nation Group, The Responsible Society, London, Conservative Political Centre, 1959, pp 31, 35, 36, 40, 41. 25 TITMUSS/​7/​29, letter, 2 May 1959, Townsend to RMT. 26 TITMUSS/​7/​29, letter, 2 July 1959, R.L. Leonard, Assistant Secretary, Fabian Society, to RMT. 27 TITMUSS/​7/​29, letter, 6 July 1959, RMT to Leonard. 28 TITMUSS/​7/​29, Fabian Society, 18 November 1959, ‘Social Policy and the Responsible Society –​Advance summary of a lecture by Professor R.M.Titmuss’, 29 TITMUSS/​7/​29, letter, 8 February 1960, Rodgers to RMT. 30 CROSSMAN, MSS.154/​3/​TM/​9, typescript of Crossman’s address at Titmuss’s Memorial Service, 1973. 31 TITMUSS/​7/​29, letter, 2 April 1960, RMT to Gaitskell; and letter, 4 April 1960, Gaitskell to RMT. 32 TITMUSS/​7/​29, letter, 30th March 1960, Rodgers to RMT. 33 S. Williams, Climbing the Bookshelves: The Autobiography, London, Virago, 2009, pp  137–​8. 34 R.M. Titmuss, The Irresponsible Society:  Fabian Tract 323, London, The Fabian Society, 1960, pp 1, 14, 17, 3, 7. 35 Ibid, p 19.

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RICHARD TITMUSS 36 Ibid, pp 4–​7. 37 Ibid, pp 6, 20. 38 TITMUSS/​7/​29, undated but late 1959/​early 1960 notes by Townsend on draft manuscript. 39 TITMUSS/​7/​29, Memorandum, 1 December 1959, Abel-​Smith to RMT, ‘Comments on “Social Policy and the Responsible Society” ’, p 2. 40 Author email correspondence with Professors Sally Sheard and Ann Oakley, both May 2019. 41 ‘Irresponsible Society’, The Guardian, 30 March 1960, p 8. 42 J.Vaizey, In Breach of Promise: Gaitskell, Macleod,Titmuss, Crosland, Boyle: Five Men Who Shaped a Generation, London, Weidenfeld and Nicolson, 1983, p 61. 43 A. Crosland, Can Labour Win?, London, Fabian Tract 324, 1960, pp 1, 15–​16. 44 Middleton, ‘ “Affluence” and the Left’, p 118. 45 ‘Selective Irresponsibility’, The Spectator, 8 April 1960, p 493. 46 D. Potter, The Glittering Coffin, London,Victor Gollancz, 1960, pp 156–​7, viii. 47 R. Jobson,‘ “Waving the Banners of a Bygone Age”, Nostalgia and Labour’s Clause IV Controversy, 1959–​60’, Contemporary British History, 27, 2, 2013, pp 130–​31. 48 ‘Selective Irresponsibility’, p 493. 49 B. Crick, ‘Socialist Literature in the 1950s’, Political Quarterly, 31, 3, 1960, pp 362–​3,  364. 50 TITMUSS/​2/​115, letter, undated but early 1959, Huxley to RMT. 51 TITMUSS/​2/​115, letter, 4 May 1959, RMT to Huxley. 52 Middleton, ‘ “Affluence” and the Left’, p 119. 53 M. Savage, Identities and Social Change in Britain since 1940: the Politics of Method, Oxford, Oxford University Press, 2010, p 116ff. 54 TITMUSS/​7/​29, letter, 8 June 1960, R.L. Leonard, Acting General Secretary Fabian Society, to RMT. 55 TITMUSS/​7/​29, clipping from The Listener, 13 October 1960, letter from Townsend, ‘The Irresponsible Society’. 56 TITMUSS/​7/​29, BBC contract with RMT, 23 June 1960, and ten-​page typescript, R.M. Titmuss, ‘The Irresponsible Society’. 57 TITMUSS/​3/​378, undated typescript, ‘The Irresponsible Society:  Imperial College’, p 8. 58 TITMUSS/​3/​370, flyer, Workers’ Educational Association, London District, for course of five lectures ‘The Irresponsible Society’. 59 TITMUSS/​3/​370, typescript ‘The Irresponsible Society:  A Re-​Assessment’, pp  7–​8. 60 L. Goldman, ‘Founding the Welfare State: Beveridge, Tawney, and Temple’, in L. Goldman (ed), Welfare and Social Policy in Britain: Essays in Honour of Jose Harris, Oxford, Oxford University Press, 2019, p 55. 61 Titmuss,‘Planning for Ageing and the Health and Welfare Services’, in Commitment to Welfare, p 91. The talk was originally given in April 1964. 62 B. Jackson, ‘Introduction’, in R.M. Titmuss, Essays on ‘The Welfare State’, Bristol, Policy Press, 2018, p xi.

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Part 4

POWER AND INFLUENCE: TITMUSS, 1960 TO 1973

16 ‘The apostle of equality’: Titmuss and R.H. Tawney Introduction From the 1930s onwards Titmuss had positively embraced the ideas of R.H. Tawney. The alleged moral and psychological distortions engendered by, in Tawney’s phrase, the ‘Acquisitive Society’ continued to trouble Titmuss, as we saw in his critique of its later manifestation, the ‘Affluent Society’. Indeed, as David Marquand pointed out, on Tawney’s eightieth birthday in 1960, the latter was not only the ‘Prophet of Equality’, but could also claim to be the ‘first critic’ of the ‘Affluent Society’.1 Tawney had also played a part in Titmuss’s appointment to the LSE, where the two were briefly colleagues. An opportunity for Titmuss to repay his debt to the older man came in 1960, when he was instrumental in arranging Tawney’s birthday celebrations. In this chapter we look at the origins of this event before re-​engaging with Titmuss’s reading of Tawney. This is done through, especially, an examination of the former’s ‘Introduction’ to a new edition of one of Tawney’s most famous works, originally published in 1931, Equality. As Ben Jackson notes, on first publication this was prominent among those inter-​war era works which had an ‘agenda setting role’ for the political left.2 The 1930s saw the beginnings of Titmuss’s political activism, and it is more than plausible to see him as one of those who had signed up to the Tawney ‘agenda’. For Lawrence Goldman, meanwhile, and looking ahead to Titmuss’s own moment in the sun, Equality was among those books which ‘shaped post-​Second World War Britain’.3 The chapter concludes with a return to one of Titmuss’s obsessions, occupational pensions, for him a prominent example of the operations of inequality in contemporary society.

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The birthday party Titmuss and Tawney were, post-​war, friends as well as colleagues. Tawney was a visitor, for both social and intellectual reasons, to Titmuss’s home, so the latter’s involvement with the eightieth birthday celebrations was unsurprising.4 It began in 1959 when Arthur Creech Jones, a Labour MP and old friend of Tawney’s, contacted Harry Nutt, General Secretary of the organisation with which Tawney had long been associated, the Workers’ Educational Association. He was looking into putting together a book to include an ‘appreciation and assessment of Tawney’s work outside his contribution to economic history’. One possible contributor was ‘Professor Titmuss who is a Socialist and whose influence is increasing in the social field’.5 Although this part of the project was not fully realised, Titmuss was now to be closely involved with the organisation of both a celebration dinner and an associated publication. From the remaining correspondence, there were clearly hurdles to be surmounted, possibly resulting from personality clashes, and in November Nutt wrote to Creech Jones that ‘I greatly hope that you will be successful in your approach to Titmuss’.6 Accordingly, a few days later Creech Jones contacted Titmuss. He suggested meeting at the House of Commons, as he was ‘anxious to have a word with you about Tawney’, and the only other person with whom he could discuss the matter was another LSE academic, the economic historian T.S.Ashton.7 But difficulties were, somehow, overcome, and in summer 1960 Creech Jones told another of Tawney’s friends, the Labour politician Lena Jeger, that Titmuss had agreed to put together a brochure to mark the birthday event.8 This was then undertaken by Titmuss, the economic historian Jack Fisher, another LSE academic, and the WEA’s J.R. Williams. Being a co-​authored work Titmuss’s exact contribution is hard to determine. However, from Creech Jones’s correspondence he clearly played a leading role. For instance, Creech Jones told one correspondent, in spring 1960, that progress was being made on preparations for the dinner, and that ‘I hope we have succeeded in conscripting Professor Titmuss for the preparation of the brochure’.9 And Creech Jones informed Tawney himself, shortly before the celebration, that ‘Professor Titmuss has prepared, with J.R.Williams, a brochure for distribution on your eightieth birthday’.10 In a rather sour note, although one which appears to reflect contemporary views of Tawney’s recently deceased spouse, and which Crossman was to revisit at Titmuss’s Memorial Service, Titmuss reminded Williams that they had ‘said nothing about his wife. I do not think we should’.11

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In the actual booklet, it is notable that certain quotes from Tawney occur in this work, and in Titmuss’s ‘Introduction’ to the new edition Equality. One of these shared quotes concerned the need for education to be available ‘without regard to vulgar irrelevancies of class or income’, a sentiment which Titmuss would have echoed.12 Problems of attribution notwithstanding, the celebratory volume does have passages and phrases of which Titmuss, if not necessarily the sole author, would surely have approved.Tawney was praised, for example, for his working assumption that ‘however economics and ethics may be separated for purposes of intellectual analysis, since they are inseparable in action they are dissociated only at the peril of society’. This arose as part of a discussion of Tawney’s critique of, in the title of another of his works, The Acquisitive Society.13 All this came at a time when, as we saw in the last chapter, Titmuss was berating ‘The Irresponsible Society’, and questioning the values of ‘The Affluent Society’. Titmuss was obviously pleased with the volume, sending Tawney a copy in advance of the dinner.14 He also told Creech Jones that he had spoken with Tawney regarding the event, and ‘reassured him about its informal and friendly character’.15 Speakers included Titmuss, George Woodcock of the Trades Union Congress, former Labour Prime Minister Clement Attlee (now Lord Attlee), and Tawney himself.16 Previewing the event under the headline ‘The Apostle of Equality’, The Observer quoted Titmuss, an ‘old friend and admirer’, to the effect that Tawney was being encouraged to ‘tell the assembled Labour Party leaders what he thought of them –​in terms suitable, of course, for an 80 year old’. Among the anticipated attendees from the Labour Party was its leader, Gaitskell.17 This particular article had a rather unusual outcome in that Titmuss received a letter from the Dean of Sociology at the University of Utah, Arthur Beeley. Beeley had read the piece, and asked Titmuss for a copy of the booklet, which the latter duly provided. The American also revealed that he had heard Tawney lecture at the LSE in the early 1930s, suggesting that he had had ‘a great influence in this country also. We frequently refer to (and routinely cite) his distinguishing books, especially his famous Religion and the Rise of Capitalism’.18

Celebrating Tawney Shortly after Tawney’s death in early 1962, Creech Jones told Jeger that plans were under way to celebrate his life, and that those involved included ‘close friends’ such as Titmuss and Michael Postan, the economic historian encountered when he and Titmuss were working on

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the wartime histories.19 In a radio broadcast a few weeks later,Titmuss told listeners that among the ‘many ways Tawney chose to serve mankind’ was through his commitment to education, and to the young. Another major preoccupation was equality, with Tawney convinced that ‘genuine equality of educational opportunity could not be achieved in a ‘society pervaded by what he called “the religion of inequality” ’. Tawney saw his task as making the young ‘think about the moral bases of society’, rather than to turn them ‘intellectually, socially and morally into well-​behaved members of a profession’. He was, then, still the ‘Apostle of Equality’ who took as ‘much exquisite care for preparing a talk for a group of social workers as he did for a group of distinguished historians’.20 Presumably, Tawney had been persuaded to talk to staff and students in Titmuss’s department. Titmuss clearly felt that Tawney’s thought retained contemporary significance. As he told a correspondent in the mid-​1960s, ‘much of what Tawney had to say is still relevant to the human condition’.21 So how did Titmuss articulate this in his ‘Introduction’ to Equality? This essay, brief as it is (15 pages), gives a number of insights into Titmuss’s thought, and perceptions of contemporary society, in a year, 1964, which also saw the return, after 13  years, of a Labour government. Titmuss’s essay both echoes previous works, for example The Irresponsible Society, and foreshadows later initiatives and ideas. It is also significant in coming at a time when, Kenneth Morgan suggests, the Labour Party was becoming as concerned, and ultimately more concerned, with issues such as ‘modernisation’ and ‘planning’ as with ‘equality’.22 If this was the case, then it would have been a worrying development for Titmuss, so investing his essay with even greater urgency. Titmuss began by reflecting that Tawney’s own ‘Introduction’ to the 1951 edition of his work came at a point at which, notwithstanding strong economic growth in the late 1940s, there was still work ahead to ‘make up for the long years when the garment of hardship had been willingly and quietly worn by the British people’. But things had since gone awry. The ‘more privileged’ had initially not realised the benefits they could obtain, and obtain better than others, from the social services, nor that ‘classless’ provision was impossible in a ‘deeply class-​divided society’. They sought, like ‘the Trade Unions, the British Medical Association and the Law Society … to be left undisturbed to live out the destinies of tradition’. Nor could they appreciate the post-​war Labour governments’‘positive achievements’ in ‘holding at bay the predatory vulgarities of land speculators and property developers’. Similarly, they had failed to appreciate that greater equality could be ‘a democratic precondition of faster economic growth’. Fast forward

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a decade, and ‘England [sic] had become a more muffled society’. The actual condition of people of all classes was ‘concealed by a combination of myth and computer incompetence’. Part of the ‘myth’ was that ordinary people had never ‘had it so good’, the Conservative Party’s battle cry at the 1959 general election. Was it therefore the case, as some social scientists claimed, that societies such as Britain and the United States had been, or were being, ‘transformed inexorably into non-​ideological welfare states’? If so, a further implication would be that the ‘social sciences would be … less concerned with values and with generalizations; more preoccupied with techniques and with providing the facts required by political engineers’.23 So was ‘equalitarian [sic] ideology’ no longer relevant? Titmuss lamented the relative dearth of empirical research which might fully illuminate Britain’s real social condition. Nonetheless, and recalling some of his own earlier work, epidemiological studies into the causes of ‘social diseases’, for example lung cancer, had ‘shown the importance of considering the whole complexity of needs, opportunities, and resources’. Social and economic inequality had ‘as many diverse and changing sources in the environment as the physical and psychological diseases of affluence’.An individual’s socioeconomic position had to be understood over the course of their lifecycle, and not just at particular points. So, for instance,‘critics of so-​called teenage affluence’ neglected to take into account the ‘whole complex system of incremental rewards, non-​monetary as well as monetary’ which differentiated the ‘professional and other classes’ from the ‘traditional and often primitive system’ of reward for manual workers.Young workers’ wages might be better than ever, and better than non-​earning school or university students, but this apparent advantage would be lost in later life.The distribution of both wealth and income was unequal, and possibly becoming more so, but a ‘statistical darkness’ surrounded these issues.This was especially true of the incomes of those at the upper end of the scale. Analyses of those further down the scale were, though, more advanced. The poor had ‘for long rendered great service to the behavioural sciences’, becoming trained in deference in the nineteenth century and so more accustomed to ‘answering embarrassing questions’. Recent studies by Townsend, Lynes, and Dorothy Wedderburn had thus revealed ‘no evidence that inequality of incomes is succumbing to economic growth’. In fact, rather the opposite.24 After noting the burgeoning problem of racial discrimination, ‘encouraged by the Commonwealth Immigrants Act and condoned by the Ministry of Labour’,Titmuss concluded with a discussion of an issue close to Tawney’s own heart, education. Just as Tawney had done,

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Titmuss had calculated the number of public school students who had gone on to occupy the upper ranks of politics, and of the leading professions.To take just one example, nearly a third of the directors of the major banks ‘received their education at one school –​Eton’. That Eton was classified as a charity simply heightened the gross nature of educational inequality as manifested by, at the other end of the scale, the lack of attention since 1950 to low achievers in secondary modern schools, and the ‘disastrous failure to reform the apprenticeship system’. So until society got rid of the dominating influences of the private sector of education we shall not have the will to embark on an immensely high standard of provision for those children whose education now finishes when it has hardly begun. Nor shall we have the moral conviction to search more intensively and more widely for greater equality in all spheres of our national life.25

What can we make of this, and what was the broader context of Titmuss’s commentary? First, we again encounter the striking idea that society has lost its way after the social gains, and social solidarity, of the 1940s. Notwithstanding the claims of ‘The Affluent Society’, Britain remained a nation of inequalities, something not mitigated by economic growth –​on the contrary.The country was being stifled by conformity, also a concern of The Irresponsible Society, and its mental as well as physical health threatened by both inequality and affluence. Inequality was, of itself, a complex phenomenon, embracing not simply income but also, for example, life chances and access to social services. For the most part, though, such phenomena were neglected by society in general, and by most social scientists. Here, then, was a call to action for social science to see individuals in their total socioeconomic context. With respect to immigration, it was briefly noted in the last chapter that Titmuss saw discrimination as a further dimension of an irresponsible society, and what he was prepared to do about this is dealt with later in this volume.And although only a passing reference,Titmuss’s comment about trades unions, corporate bodies just like, say, the British Medical Association, pursuing their own self-​interest, is again revealing, given their contemporary strength within the Labour Party. Titmuss’s remarks on education and young people should also be seen in their wider context. The Labour Party had, in principle, been committed to comprehensive education since the mid-​1950s, seeing greater educational opportunity as one means of promoting social mobility. A  few months prior to the 1964 General Election, Tony

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Benn recorded a dinner at Peter Shore’s home. This was also attended by Crossman and Titmuss, and discussion, at which Benn implausibly claimed to be ‘only a spectator’, centred on Labour’s educational policy. Questions such as the governance of universities, and how to integrate public schools, were debated. In a revealing remark, Benn concluded that he ‘wondered whether there has been as much preparatory work on these questions’ as there should have been.26 Titmuss himself, though, clearly had interests in educational reform. In early 1964 he was invited to become a patron of the Council for Educational Advance by Fred Jarvis, a Labour and trade union activist, later General Secretary of the National Union of Teachers.Titmuss agreed.27 The Council sought to promote education, adequate provision of which it saw as the basis of a healthy and successful society. In an earlier incarnation, Tawney had been its president.28 After Labour’s victory in 1964, the government promoted the comprehensive cause. The recent Robbins Report (‘Robbins’ being Titmuss’s LSE colleague, Lionel Robbins), meanwhile, had advocated an expansion of the number of university places. But would this have been enough for Titmuss? It seems unlikely, since what he described as the ‘dominating influences of the private sector of education’ would remain unchallenged, then as now. It is notable that Eton, bastion of privilege, came in for criticism in his introduction, and in The Irresponsible Society. More than this, given existing inequalities, children of the poorer classes would already be disadvantaged by the time they entered primary school. As to ‘so-​called teenage affluence’, this was again an acknowledgement of wider social trends. Juvenile delinquency had been a concern since at least the late 1950s, and the year Titmuss’s essay was published, 1964, saw some of the worst violence involving groups of young people in gangs of ‘mods’ or ‘rockers’. Much of this was blamed on ‘affluence’.29 This was plausible to the extent that full employment, and the changing dynamics of family life, allowed young people greater freedom than had been available to preceding generations.30 However, as Titmuss sought to show, while young people might be relatively well off at a particular stage in their lives, this advantage could decline according to their position in class and occupational structures. Once again, it was the fundamental problem of inequality which had to be addressed. On ‘ideology’, Titmuss was acutely aware of developments in American social science. In challenging the idea of advanced societies transforming into ‘non-​ideological welfare states’, he had in mind works such as Daniel Bell’s The End of Ideology: On the Exhaustion of Political Ideas in the Fifties. Bell argued that ‘the basic political drift’ of

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the American left-​wing intelligentsia in the 1940s and 1950s had been ‘non-​ideological’. It had come to find ‘new virtues’ in the United States because of, among other things, ‘the acceptance of the Welfare State’.31 Similarly, the economic historian W.W. Rostow, analysing the stages of economic growth, claimed that the last of these, ‘the fully mature economy’, ultimately concerned itself with ‘the provision of durable consumers’ goods and services (as well as the welfare state) for its increasingly urban –​and then suburban –​population’. This point had been reached, or was about to be reached, by Western Europe, Japan, and the United States.32 Both of these books came out in 1960, received widespread publicity, and Bell was explicitly cited in Titmuss’s notes. It is not hard to imagine him grimacing at apparently uncritical views about the benefits of material affluence, and of the success of a ‘welfare state’.As we shall see in later chapters,Titmuss, especially when he was involved with President Johnson’s ‘War on Poverty’, further engaged with what he saw as the fallacies of certain strands of American social science. Closer to home, Bell’s ideas in particular had a profound influence on Labour Party ‘revisionists’, notably Crosland. Indeed he and Bell became close friends.33 This again alerts us to the need to see Titmuss as taking part in contemporary Labour Party disputes about which road to follow. Finally, some of the ideas in Titmuss’s ‘Introduction’ had been articulated in a work published two years earlier, Income Distribution and Social Change: A Study in Criticism.This was dedicated to Titmuss’s daughter, Ann, while the ‘Acknowledgements’ contain the rather oblique comment that the ‘external costs of this book in family disservices are difficult to compute. Only Kay and Ann know the answer’.34 It is difficult to know exactly what this meant. But research for the book, and its publication, coincided with Ann quitting her much disliked school, Haberdashers’ Aske’s, and, in 1962, going up to the University of Oxford.35 Titmuss’s research assistant,Tony Lynes, was also acknowledged although not, perhaps, as much as he should have been. The book itself was, for the most part, an attempt to dispel the ‘statistical darkness’ on income distribution and inequality. However, as was usually the case, empirical and technical data sat alongside some more polemical, and moralising, points. The whole notion that economic growth post-​1945 had led to a decline in inequality, which had been further eroded by the provisions of the ‘welfare state’, was, as always, disputed. For Titmuss, part of the problem lay in analysts’ reliance on material provided by the Board of Inland Revenue. For instance, his old sparring partner, Enoch Powell, had used such data in a book arguing the case for declining inequality.The acceptance of such

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data was ‘one of the many symptoms of the intellectual narrowness of writers on public finance and related subjects’, for they ignored the findings of ‘neighbouring fields’ such as sociology.Therefore his book’s purpose was ‘a severely limited one’: to examine the data on which claims about declining inequality were based, reinterpret some other scholars’ work and analyse ‘a number of social and demographic factors of change in their bearing on … questions of equity and welfare’.36 Among Titmuss’s conclusions was that the ‘concept of poverty’ had to be placed in ‘the context of social change’, and interpreted in ‘relation to the growth of more complex and specialized institutions of power, authority and privilege’. Each generation had to revise its take on poverty if it wanted to ‘uphold its claim to share in the constant renewal of civilized values’. Titmuss also challenged those, such The Economist, advocating reductions in progressive taxation in order to address the problem of tax avoidance. In a very characteristic rejoinder, such an approach meant that ‘the only answer to the challenge of moral behaviour is –​in the ultimate analysis –​to abolish the need to be moral’. He also reiterated his belief that the Second World War had been a ‘stimulus to social inquest’ which had, albeit temporarily, weakened the ‘forces of inertia and resistance to change’. In a barnstorming finish, which prefigures some of the points raised in the Tawney volume as well as illustrating more general issues which recur throughout his work, Titmuss claimed that his book had shown, first, that ‘fact and economic theory are at variance’. Any social analysis which excluded factors such as age and family circumstances, while also omitting wealth (as opposed simply to income), the impact of education on life chances, and the meaning of power, could not be relied upon ‘in the context of the social changes we have depicted’. ‘Ancient inequalities’ had ‘assumed new and more subtle forms; conventional categories are no longer adequate for the task of measuring them’.37 Townsend later recalled Income Distribution and Social Change as a ‘devastating analysis of the inadequacies of the information we had about income distribution’ which played ‘a big part in the lives of some of us at the LSE at that time’. Consequently, attempts were made to stimulate discussion of issues such as inadequate benefit levels, and this in turn fed into the creation of the Child Poverty Action Group (CPAG).38 The book was also more immediately, and widely, noticed. For example, it was the basis of a series of articles in New Statesman in autumn 1962.39 And it led to Titmuss’s appearance on the BBC television programme ‘Tonight’ shortly after publication. The programme’s producer subsequently thanked Titmuss for contributing at short notice. The ‘item was an excellent one’, he flatteringly

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continued, and expressed the hope that ‘there will be an opportunity of inviting you into “Tonight” again in the near future’. For his troubles, Titmuss received a fee of ten guineas.40 The volume also received a highly favourable review in the left-​wing journal Tribune, from the Labour MP Raymond Fletcher. Fletcher’s piece was entitled ‘Who Believes Socialism Is Old-​Fashioned? The Titmuss Bombshell’, and in it he extolled the analysis of ‘probably the most eminent of social investigator of our time’. Titmuss had shown the falsity of claims that inequality was decreasing. Such claims had been advanced not only by the political right, but also by the likes of Crosland. As such,Titmuss’s book was ‘of tremendous significance for a Labour movement committed to the policy of greater equality’.41

Occupational pensions revisited: more inequality In the late 1950s, Titmuss applied to the Houblon-​Norman Fund, based at the Bank of England, for financial support.The fund had been established in 1944, the 250th anniversary of the Bank’s foundation, ‘to promote research into and disseminate knowledge of the working interaction and function of financial and banking institutions in Great Britain and elsewhere and the economic conditions affecting them’. Titmuss told Tom Simey and Barbara Wootton, who were to act as referees, that he was ‘applying for a grant to pay the salary of a research assistant’. In a revealing passage, and as we have seen an ongoing concern for Titmuss, he informed his friends that ‘We are so short of money at the School and the problem of financing research is really becoming quite desperate’.42 Titmuss reported in his application that he had been accumulating material for three years ‘for a one or two volume study of The History of Occupational Pensions in Britain’.This was the first time this had been attempted, and he had already drafted several chapters. He was therefore applying for funding ‘to enable me to employ a chartered accountant, Mr T.A. Lynes, as a research assistant’. Titmuss had already been awarded a small grant from LSE research funds, but this was due to expire. He had, though, been ‘most impressed with Mr Lynes’ qualities as a research worker, and consider that he is eminently fitted to undertake this study of the development of tax treatment of pension and superannuation schemes’.43 The sum of £850 was duly awarded.44 Titmuss was revisiting another form of inequality in contemporary society, the benefits accruing to those fortunate enough to be in occupational pension schemes. As we have seen, for Titmuss such benefits were pernicious and divisive, manifestations of ‘acquisitiveness’ at the expense of social solidarity and shared moral purpose.

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There was to be an interesting coda to this project. We have seen examples of the relentless workload which Titmuss took upon himself in his attempt to establish his own reputation, and that of his colleagues and his department, and the resulting flow of research-​based publications.All this was with the aim of recasting Social Administration as an academic field with real policy engagement, rather than simply a platform from which to conduct social work training. But the latter had proved, especially in the period 1954–​57 when the social workers’ crisis was in full flow, challenging and time-​consuming, and in many respects a diversion from what Titmuss felt he, and others, should be doing. All this began to take its toll, not least in health terms. In a confidential letter to Sydney Caine in autumn 1960, he addressed the ‘problems of administering the Social Science Department’, the ‘burden’ of which was becoming ‘excessively heavy’. At a recent visit to the tuberculosis sanatorium he had again been warned to cut down his activities. He had, accordingly, resigned his chairmanship of the Institute of Community Studies, and had withdrawn from various committees and from external examining. In the course of his ten years in the department it had expanded considerably, and he now had some form of responsibility for up to 50 people, with much time spent on managing them. In developing the department’s research capacities, furthermore, grants from ten different outside sources presently had to be administered. He had, since his arrival at the LSE, sought senior appointments, but only one readership had resulted (Donnison). Titmuss acknowledged that he was ‘partly responsible’ for all this.The recruitment of a ‘younger, lively and extremely loyal and co-​operative staff ’ was rewarding, but inevitably made ‘demands on me in all sorts of ways’.Titmuss claimed to have delegated responsibility as far as possible, and, in the event of Donnison being awarded a professorship in the near future, further tasks could be devolved to him. But this would not ‘solve all my problems’, not least around the development of research. He therefore sought a personal research assistant.Titmuss accepted that such a post could not be funded by the LSE, and asked the director’s advice about applying for a grant from the Nuffield Foundation.45 Although he did not put it this way, Titmuss was essentially a victim of his own success. Caine expressed a ‘great deal of sympathy with you in your problem and with the proposal that you make for solving it’.The School ought to address such issues ‘out of the considerably enlarged research budget that I should like to hope the Governors will be able to provide next quinquennium’. Precisely because it was the sort of thing the LSE should be doing, Caine was reluctant to have Titmuss apply to the

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Nuffield. He offered to explore the possibility of finding funds from the present research budget, not least because of ‘the very great importance of your not over-​doing things –​which carries with it the corollary that you ought, so far as possible, to be spared from minor activities that could be handled by someone else’. He was prepared to approach the governors to this effect, and to explore ways of continuing such support in the future.46 Titmuss thanked Caine for his suggestion, and asked him to move ahead on the basis suggested. As Caine had requested, he gave some costings, remarking too that ‘I cannot at the moment think of anyone more suitable to help me’ than Lynes.The latter’s salary was at present partly covered by support from the Houblon-​Norman Fund, but this was due to run out in September 1961.47 As promised, Caine then approached the Chair of Governors, Lord Bridges, attaching the correspondence between himself and Titmuss. The latter was ‘more or less self-​explanatory’, Caine adding that Titmuss had been suffering for some time from tuberculosis, which had restricted his activities. Normally he would have brought the matter to the LSE’s Standing Committee, but since Titmuss was a member of that body, and given that ‘his state of health is part of the ground for proposal’, he would prefer that Bridges personally deal with the matter. What he sought, therefore, was the power to make Lynes a formal offer. The chairman returned Caine’s letter with the handwritten comments ‘I agree entirely. Pl make the formal offer Lynes’.48 In the event, the promised history of occupational pensions did not appear, but Titmuss was to continue his onslaught on these, and their providers. Lynes’s own interest in pensions also continued. This was expressed in two of his early publications. In 1962 the ‘Occasional Papers’ series published his work on the development of national assistance scales. In his ‘Acknowledgements’, Lynes thanked Titmuss for making it possible ‘for me to attempt this task and for his continuous help and encouragement’. Titmuss, in his ‘Foreword’, noted that the volume refuted any claim that those receiving national assistance had benefited from growing national prosperity. On the contrary, Lynes had revealed ‘a growing inequality –​an inequality which has been concealed by failure to make sufficient allowance for the impact of rising prices on those in the lowest income groups’. The data presented was therefore ‘an important contribution to the study of income distribution in Britain’.49 The following year, Lynes’s produced a Fabian Society pamphlet critiquing the Conservative government’s pension plans, and was able to draw on the recently published Income Distribution and Social Change.50 What is notable here is how Titmuss and his co-​workers

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see these various phenomena as organically interconnected. National assistance scales can tell us about income distribution, which, in turn, should inform our analysis of pensions. But the really key point was that further evidence had been uncovered about the growth of inequality in contemporary society. In its way, all this was a further tribute to Tawney.

Conclusion R.H. Tawney was a major influence on Titmuss from the 1930s and beyond the older man’s death. Through the rest of the 1960s and into the 1970s Titmuss continued to engage with his work and legacy. As we shall see in Chapter 22, for example, he was to help a young scholar, Ross Terrill, with his thesis on Tawney, subsequently published as a book which remains a useful source, as well as containing some illuminating material about both Titmuss and Kay. Tawney had been relentless in unpicking the idea of inequality in society, and in addressing the problems engendered by modernity, and especially acquisitiveness. In so doing, he presented a moral view of how society should be reformed and should conduct itself. Titmuss, although he rejected Tawney’s Christianity, largely bought into this intellectual package. As such, he likewise became an ‘Apostle of Equality’. Notes 1 D. Marquand, ‘R.H. Tawney: Prophet of Equality’, The Guardian, 26 November 1960, p 6. 2 B. Jackson, Equality and the British Left: A Study in Progressive Political Thought, 1900–​64, Manchester, Manchester University Press, 2007, p 30. 3 L. Goldman, ‘Founding the Welfare State: Beveridge, Tawney, and Temple’, in L. Goldman (ed), Welfare and Social Policy in Britain since 1870: Essays in Honour of Jose Harris, Oxford, Oxford University Press, 2019, p 45. 4 Oakley, Father and Daughter, pp 95, 197. 5 CREECH JONES, MSS.Brit.Emp. s332 box 6, file 3, letter, 14 May 1959, Creech Jones to Nutt. 6 CREECH JONES, MSS.Brit.Emp. s332 box 6, file 3, letter, 19 November 1959, Nutt to Creech Jones. 7 TITMUSS/​7/​1, letter, 29 November 1959, Creech Jones to RMT. 8 JEGER, JEGER/​1/​8, letter, 30 June 1960, Creech Jones to Jeger. 9 CREECH JONES, MSS.Brit.Emp. s332 box 6, file 3, letter, 16 March 1960, Creech Jones to Lady Simon of Wythenshaw. 10 CREECH JONES, MSS.Brit.Emp. s332 box 6, file 2, letter, 9 September 1960, Creech Jones to Tawney. 11 CREECH JONES, MSS.Brit.Emp. s332 box 6, file 7, letter, 9 August 1960, RMT to Williams; for a sympathetic reappraisal of Jeanette Tawney, L. Goldman The Life of R.H.Tawney: Socialism and History, London, Bloomsbury Academic, 2014.

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RICHARD TITMUSS 12 J.R.Williams, R. Titmuss, and F.J. Fisher, R.H.Tawney: A Portrait by Several Hands, London, Shenval Press, 1960, p 3; R.M. Titmuss, ‘Introduction’, R.H. Tawney, Equality, London, George Allen and Unwin, new edn, 1964, p 15. 13 Williams, Titmuss, and Fisher, R.H.Tawney, pp 9–​11. 14 TITMUSS/​7/​1, letter, 18 November 1960, RMT to Williams. 15 CREECH JONES, MSS.Brit.Emp. s332 box 6, file 7, letter, 26 October 1960, RMT to Creech Jones. 16 TITMUSS/​7/​1, printed programme for the dinner in honour of Tawney’s 80th birthday, House of Commons 10 December 1960. 17 ‘Apostle of Equality’, The Observer, 27 November 1960, p 13. 18 TITMUSS/​7/​1, letter, 19 January 1961, Beeley to RMT. 19 JEGER, JEGER/​1/​8, letter, 13 February 1962, Creech Jones to Jeger. 20 JEGER, JEGER/​1/​8, typescript, dated 4 April 1962, of radio discussion on Tawney, pp 17–​19. 21 TITMUSS/​7/​1, letter, 13 July 1966, RMT to Canon R.H. Preston. 22 K.O. Morgan, Ages of Reform: Dawns and Downfalls of the British Left, London, I.B. Tauris, 2011, pp 137–​41. 23 Titmuss, ‘Introduction’, Tawney, Equality, pp 9–​10, 13, 15. 24 Ibid, pp 11, 12, 18, 19–​20. 25 Ibid, pp 22, 23–​4. 26 T. Benn, Out of the Wilderness: Diaries, 1963–​67, London, Hutchinson, 1987, p 63, entry for 17 September 1963. 27 TITMUSS/​7/​72, letter, 6 February 1964, Jarvis to RMT; and letter, 12 February 1964, RMT to Jarvis. 28 Goldman, The Life of R.H.Tawney, pp 268–​9. 29 B. Harrison, Seeking a Role: The United Kingdom 1951–​1970, Oxford, Oxford University Press, 2009, pp 353, 358, 214. 30 P. Thane, Divided Kingdom: A History of Britain, 1900 to the Present, Cambridge, Cambridge University Press, 2018, pp 238–​40. 31 D. Bell, The End of Ideology: On the Exhaustion of Political Ideas in the Fifties, Glencoe, IL, The Free Press, 1960, p 297. 32 W.W. Rostow, The Stages of Economic Growth, Cambridge, Cambridge University Press, 1960, p 12. 33 P. Diamond, The Crosland Legacy: The Future of British Social Democracy, Bristol, Policy Press, 2016, pp 107, 148, 190, 301. 34 R.M.Titmuss, Income Distribution and Social Change: A Study in Criticism, London, George Allen and Unwin, 1962, Dedication, Acknowledgements. 35 Oakley, Father and Daughter, p 92ff. 36 Titmuss, Income Distribution, pp 15–​16, 195, 193, 20. 37 Ibid, pp 187–​8, 197–​8, 188, 198–​9. 38 Townsend quoted in R. Lowe and P. Nicholson (eds), ‘The Formation of the Child Poverty Action Group’, Contemporary Record, 9, 3, 1995, p 620. This was based on a witness seminar on the CPAG’s early years. 39 The last of four articles, the revealingly entitled ‘The New Language of Inequality’, appeared in New Statesman, 21 September 1962, pp 354–​5. 40 TITMUSS/​4/​558, letter, 1 October 1962. Peter Batty, Assistant Editor, ‘Tonight Programme’, to RMT, and BBC payment slip. 41 R. Fletcher,‘Who Believes Socialism Is Old-​Fashioned? The Titmuss Bombshell’, Tribune, 28 September, 1962, p 5.

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‘The apostle of equality’: Titmuss and R.H. Tawney 42 TITMUSS/​AO, identical letters, 23 February 1959, RMT to Simey and to Wootton, and notes about the Fund. 43 TITMUSS/​AO, ‘Houblon-​Norman Fund Application Form’, undated but February 1959. 44 TITMUSS/​AO, letter, 19 June 1959, John Fforde, Houblon-​Norman Fund, to RMT. 45 LSE/​Staff File/​Titmuss, letter, 21 September 1960, RMT to Caine. 46 LSE/​Staff File/​Titmuss, letter, 27 September 1960, Caine to RMT. 47 LSE/​Staff File/​Titmuss, letter, 4 October 1960, RMT to Caine. 48 LSE/​Staff File/​Titmuss, letter, 11 October 1960, Caine to Bridges, and returned with handwritten notes. 49 T. Lynes, National Assistance and National Prosperity:  Occasional Papers on Social Administration No.5, Welwyn, Herts., The Codicote Press, 1962, ‘Acknowledgements’ and ‘Foreword’. 50 T. Lynes, Pension Rights and Wrongs: A Critique of the Conservative Scheme, Fabian Tract 348, London, The Fabian Society, 1963.

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1. Titmuss (centre) with brother Harold and father, family farm, Bedfordshire. Photo courtesy of Ann Oakley

2. County Fire Office Soccer Team, Titmuss back row, right. Photo courtesy of Ann Oakley

3. Titmuss and Kay, Geneva, 1936. Photo courtesy of Ann Oakley

4. Titmuss and Ann, late 1940s. Photo courtesy of Ann Oakley

5. Titmuss, 1953. Photo courtesy of Ann Oakley

6. Mauritius, 1960, Titmuss on right of photo, which also includes Brian Abel-​Smith and Tony Lynes. Photo courtesy of John Sarbutt

7. Titmuss, Israel, 1963, Israel Katz on right of photo. Photo courtesy of Ann Oakley

8. Titmuss as guest speaker in the BBC World Service programme ‘Asian Club’ talk on ‘The Individual versus The Planned Society’. Also in the photo, Chairman of the programme, Mrs Nandini Iyer. Photo courtesy of Ann Oakley

9. Titmuss, Chicago 1966 (?), Alvin Schorr on left of photo. Photo courtesy of Ann Oakley

10. Community Relations Commission, Titmuss on left of photo, Archbishop of Canterbury in the Chair. Photo courtesy of Ann Oakley

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11. LSE Department of Social Science and Administration, 1971, Titmuss front row, centre. Photo courtesy of BLPES

17 Mental health, community care, and medical education Introduction Titmuss was concerned, from the 1930s onwards, about the psychological effects of modernity.This informed his approach to social medicine, given its aspiration to see patients and their families in their total contexts, and not just as clinical entities. In turn, this suggested there was more to individual, and social, wellbeing than simply the provision of medical services. Consequently,Titmuss was a critical supporter of community care which, although not a new idea, had nonetheless expanded in scope with the advent of the ‘welfare state’. Although community care can take a number of forms, here we are especially concerned with its relationship to mental health, an area with which Titmuss directly engaged. He was also a critic of what he saw as the overweening ambitions of ‘welfare professionals’, including medical doctors. The training of the latter, he argued, paid too little attention to the patient as a psychological and social being. Social workers, too, could behave in an overbearing way, but Titmuss was keen to defend their role as ‘front line’ workers in the ‘welfare state’, and to see their numbers expanded. This chapter examines Titmuss’s approach, in the 1960s, to mental health, community care, and medical education.These activities should be seen in the context of both his critique of ‘The Affluent Society’, and his contribution to the debates over the future of local authority social services, discussed in Chapter 19.

Mental health and community care In his input to Labour’s Working Party on the NHS in the late 1950s, Titmuss had, as we have seen, raised concerns about proposed changes

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in mental healthcare, non-​medical staffing in health and welfare settings, and the need for an enquiry into medical education. He further expressed such concerns more broadly around this time. So, for instance, in spring 1959 he wrote to The Times commending a recent letter from Lady Hurtwood, encountered in Chapter 6 when she sought Titmuss’s advice on her campaign for what was to become the 1948 Children Act. Hurtwood was right, Titmuss argued, to call for an end to the Ministry of Education’s ban on the extension of nursery school provision.The Ministry’s recent agreement to improve child guidance facilities was, though, to be welcomed, as were the ‘developments in mental health services foreshadowed by the Bill now before Parliament’. What was needed, however, was the development of preventive mental health services alongside improved ‘rescue’ services, and playing space for children should be part of such a programme.1 A few weeks later,Titmuss addressed the specific issue of ‘Community Care as Challenge’. This claimed that, since the war, both law and broader opinion had moved against institutional care as a ‘means of resolving or alleviating the health and social problems of modern society’. Psychiatrists had shown, for instance, that children with psychological problems were best treated in a more sympathetic environment. Any shift towards community care, however, had to be properly handled.The newly publishedYounghusband Report had highlighted a severe shortage of social workers and their back-​up staff. Consequently, if ‘community care was not to spell community irresponsibility what is first needed is a definitive policy and legislation, then leadership, then a willingness to spend the money required.The policy rests squarely on the shoulders of the Minister of Health’.2 As well as the call for more care in the community, two points stand out. First, Titmuss’s article came a few days after the beginning of the chain of events leading to the publication of The Irresponsible Society (and note its reference to the potential for ‘community irresponsibility’). Second,Titmuss was clearly reflecting on the Guillebaud Report’s proposals for an extension to community care, the similar suggestion from the Royal Commission on Mental Health (the Percy Commission) which had reported in 1957, and the impending 1959 Mental Health Act.As Vicky Long points out, this allowed local authorities to ‘establish community mental health services’, a development ‘accelerated two years later when the Minister of Health announced plans to close down the psychiatric hospitals’.3 The announcement to which Long alludes was that by the Enoch Powell, now Minister of Health, at the 1961 Annual Conference of Britain’s largest mental health charity (and predecessor of Mind), the National Association for Mental Health (NAMH).This was the event,

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which had the overarching theme of ‘Mental Health is Everybody’s Business’, at which Powell made his famous, and startling,‘water towers’ speech.4 Powell proposed the gradual closing down of large-​scale mental hospitals, many built in the nineteenth century, and their replacement with more community-​oriented services. The old hospitals stood ‘isolated, majestic, imperious, brooded over by the gigantic water-​tower and chimney combined which rises unmistakable and daunting out of the countryside’.5 Powell’s intervention should also be seen as part of his more general concern to rationalise hospital provision. As John Welshman argues, the Hospital Plan for England and Wales, published in 1962,‘confirmed that the Ministry of Health’s plans for community care were directly related to a proposed reduction in the number of hospital beds for the mentally ill and “subnormal” ’. Powell thus played a significant part in pushing forward a community care agenda.6 There is a further important contextual point. A few days before his NAMH speech, Powell was challenged by Kenneth Robinson, a Labour health spokesman, to set up a Royal Commission on Medical Education. Robinson claimed that British medical education lagged behind that of the United States and some European countries, a view shared ‘by many younger doctors and medical students and most psychiatrists because [Britain was] particularly backward in the teaching of psychological medicine’. Powell declined on the grounds that his Ministry’s role in medical education was limited.7 This was true in that universities, and not the state, determined entry to medical schools. Titmuss, too, spoke at the NAMH conference, having been in close contact with the organisation since the late 1950s.8 The Association was, for example, involved with the Mental Health course. In spring 1960, Titmuss told Sydney Caine that, as agreed, a new member of staff had been taken on. This colleague would participate in training courses involving mental health. Titmuss would also, ‘of course, be notifying the Association for Mental Health’. He was sure, too, that ‘Sir Otto Niemeyer will be glad to know that the School is making some contribution’.9 Niemeyer, NAMH treasurer, had previously been the chair of LSE governors, in which capacity he had approved Titmuss’s appointment in 1950. At the 1961 conference, Titmuss contributed to the panel ‘Community Care –​Fact or Fiction?’ His speech, an attack on Powell’s strategy, was reproduced in The Spectator with the provocative title ‘Care –​or Cant?’ Reflecting his love of gardening, Titmuss produced a horticultural analogy.After suggesting that opinion was often deluded by assuming that mooted, or promised, reforms were actually put into practice, he asked what had happened to that ‘ever-​lasting cottage

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garden trailer,“Community Care”?’ Did not the phrase evoke ‘a sense of warmth and human kindness, as loving as the wild flowers so enchantingly described by Lawrence in Lady Chatterley’s Lover?’ –​the novel’s publishers had recently been acquitted of obscenity, and presumably Titmuss was implying he had read it. In reality, little progress had been made since the official enquiry into social workers in mental healthcare a decade previously. Although the 1959 Act encouraged patients’ discharge from mental hospitals, dispersing them ‘in the community before we have made adequate provision … is not a solution; in the long run not even for HM Treasury’. Expenditure on the mentally ill was probably less, in real terms, than in 1951. While Powell envisaged a positive future for community care, he was more sceptical. Certain specific policy commitments were required, including a grant for 1961–​62 of £10 million to local authorities for mental health work, and central government funding for more social work training and more social workers. As to doctors, they needed to be ‘better equipped to understand and deal with the social and psychological effects of medical care’. Reform of medical education had long been debated, but a Royal Commission was needed to advance matters. Overall, as things presently stood, ‘we are drifting into a situation in which by shifting the emphasis from the institution to the community –​a trend which in principle and with qualifications we all applaud –​we are transferring the care of the mentally ill from trained staff to untrained or ill-​equipped staff or no staff at all’.10 Titmuss did not follow his analogy through, but presumably the ‘ever-​lasting cottage garden trailer’ was in danger of dying of neglect.To carry the story forward, care for the mentally ill remained (and remains) very much a ‘Cinderella service’.The closure of the nineteenth century hospitals, for example, was, in Long’s words,‘a drawn out process’, which of itself had implications for community care.11 So Titmuss’s fears were justified. His speech, though, was well received, both generally and in NAMH circles. The organisation’s General Secretary, Mary Appleby, wrote to him in the conference’s immediate aftermath. He did not have to be told ‘what a splendid performance it was … and what a blow you have struck for positive mental health’.The speech had thus started reformers on ‘a new track of positive action’.12 Titmuss was likewise contacted, from the Ministry of Health, by Albertine Winner, an old friend and now a visiting lecturer at LSE.Titmuss had sent her a copy of the speech, and, as she had further gathered from press reports, ‘it was pungent and hard hitting and said a lot of things that needed saying’.13 Titmuss’s comments on the need for a Royal Commission on Medical Education, meanwhile, received particularly widespread

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publicity.14 The Lancet saw the speech as a ‘devastating analysis’, noting that an ‘unexpected though persistent topic’ at the conference had been ‘the need to improve the place of psychiatry in medical education’.15 Kenneth Robinson returned to the issue in the Commons a few days after the NAMH conference.What was Powell doing to ‘stimulate the teaching of psychological medicine to medical students’, and to increase the number of psychiatrists? Powell reiterated that he had no powers with respect to the medical curriculum. The number of psychiatrists, though, was steadily increasing.16 Parts of Titmuss’s speech were also cited verbatim in the Lords when Lord Feversham, NAMH chair, spoke in spring 1961 during a debate on hospital services. He repeated, for example, Titmuss’s jibe about the Treasury, remarking that on three of his demands, including that for the reform of medical education,‘I very much see eye to eye with him’.17 Such agitation notwithstanding, an investigation into medical education was going to have to wait for the return of a Labour government in 1964. Shortly before this was set up, Titmuss addressed the question of enhancing the status of general practitioners. In so doing, he was contributing to a broader debate about remuneration and conditions, issues about which GPs were, at that point, extremely unhappy. In a 1965 article in The Lancet, Titmuss argued that the ‘generalist’ was important to a modern society in thrall to ‘the uncritical worship of technocracy’, whose benefits could be ‘measured by the monsters it produces and we think we love’. The family doctor’s role, then, was to ‘protect the patient from the excesses of specialised technocracy; to defend him against narrow-​mindedness; and to help him humanely find his way among the complex maze of scientific medicine without resort to self-​diagnosis or charlatanism’. The GP performed an essential task which was ‘difficult to evaluate in economic criteria’, and was thus ‘about personal freedom which, as we all know, is above price’.18 This rather cryptic remark was, in the first instance, about freedom of clinical practice, but can also be more broadly construed as being about ‘choice’ in welfare provision, as well as demonstrating Titmuss’s commitment to individual choice. His article placed the GP firmly in his social context, as another form of community care. As Welshman remarks, this was part of Titmuss’s broader strategy to shift preventive medicine away from Medical Officers of Health, and towards general practice.19 Titmuss combined a number of his concerns in an exchange of letters, prompted by the Lancet piece, with a Dr W. Levy. Levy told Titmuss that while many GPs were aware of the ‘social setting of their work’, the overall problem lay in the teaching of medical students. Unsurprisingly, Titmuss concurred, remarking that ‘the more I think

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of these problems of general practice the more I am driven back to the need for reform in medical education’.20 As usual campaigning on several fronts, Titmuss also agreed, in early 1965, to give evidence to a Royal College of Physicians committee investigating the training of medical administrators.21 The training and role of ‘welfare professionals’ was on his mind.

The Royal Commission on Medical Education (the Todd Commission) The establishment of the Royal Commission on Medical Education (the Todd Commission) was announced by Prime Minister Harold Wilson in late June 1965. He told the Commons that its brief was to ‘review medical education, undergraduate and postgraduate’ and,‘in the light of national needs and resources, including technical assistance overseas’, to advise the government ‘on what principles future development (including its planning and coordination) should be based’.There was to be a particular focus on the number, location, and scope of medical schools. The Commission was to be chaired by the distinguished scientist Lord Todd (winner of the Nobel Prize for Chemistry in 1957), with other members, medical and non-​medical, to be announced. More immediately, a review of medical manpower was being carried out to ascertain what measures could be taken in the short term.22 Shortly afterwards, Titmuss agreed to join the Commission.23 In August, he told one of his regular American correspondents, Mike Miller, that he had taken on several new commitments, ‘the most time-​consuming being membership of a Royal Commission on medical education and the profession itself. It should be fascinating and I hope to keep a “sociological diary” ’.24 Two months later, Titmuss confirmed, to the same correspondent, that ‘under great pressure’ he had agreed to join various official bodies, including the Royal Commission.This was ‘likely to involve visits to the USA and the USSR next summer and fall’.25 In a grumpy commentary on the setting up of the Commission, the BMJ agreed the need for more doctors, especially as demand for medical services was increasing. The need would be less, though, if ‘large numbers’ of doctors had not been ‘emigrating for years to countries where conditions of practice are more attractive’. In part a routine complaint about remuneration, this also drew attention to the purported loss of doctors to other nations.26 The Commission’s origins lay in the shortcomings of an earlier body, the Willink Committee on Medical Manpower, 1954 to 1957, when it came to future manpower requirements. Revealingly, one of the latter’s earliest critics was Titmuss’s

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old friend François Lafitte. Concerns about future staffing needs were coupled with unease about the number of overseas doctors being recruited to the NHS, and the perception that medical staff trained in Britain were emigrating in significant numbers.As we shall see,Titmuss addressed both these issues.Various other enquiries had suggested the need for an expansion of medical education, an expansion which could not be met by existing provision. Criticisms of medical education in London were also increasingly voiced, again a matter of concern to Titmuss. The Commission formally began its work in September 1965.27 Unsurprisingly given his comments to Miller, Titmuss was determined to limit his involvement. For instance, he told Todd in 1966 that he was not prepared to write a draft chapter for the final report as his ‘teaching and administrative responsibilities’ were presently so heavy as to rule out any such work. And, in any event, he had told the Minister of Health at the outset that ‘it would not be feasible for me to undertake any substantial writing or travelling commitments’.28 This is not to say, though, that Titmuss was not his usual assiduous self in carrying out the work he thought appropriate for the Commission, and in sharing his views with friends and colleagues. One particularly congenial location for doing so was the Keppel Club, named after the street home to the London School of Hygiene and Tropical Medicine (LSHTM). The club had been founded in the early 1950s by radical staff at the School of Hygiene, with membership deliberately kept small. At various points it included Abel-​Smith,Townsend, Morris,Albertine Winner, and Margot Jefferys, all close to Titmuss.29 A meeting in early 1966 heard a paper from Jock (J.A.D.) Anderson of Guy’s Hospital on medical education, with Titmuss remarking that ‘much emphasis is placed on research and higher degrees by those in authority at medical schools. Little thought is given to the quality of teaching in respect of members of staff ’.30 Titmuss also utilised the expertise and contacts of colleagues such as Abel-​Smith and Morris. For instance, Abel-​Smith was able to report on the admissions policies of St Thomas’s Medical School in his capacity as a hospital governor.The limited information he was able to gain showed that a policy was in place to allocate 15 per cent of places to women and 5 per cent to overseas students. A few years earlier, a survey had suggested that one third of students were the sons of doctors, and half of this number had parents educated at St Thomas’s. Rather ominously, Abel-​Smith concluded that he had gained the impression ‘that I  would not be encouraged to ask any further questions’.31 Morris, meanwhile, was sent, in confidence, documents for comment. In late 1967, Titmuss asked him to look at ‘this draft part of the

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Chapter on Undergraduate Education. The first draft that came from the Secretariat was so awful  –​without a single reference to Social Medicine!’32 As Webster points out, most of the Commission’s work was carried out by subcommittees whose activities corresponded to the chapters in the final report, and it is clear that Titmuss was closely involved with discussions on the undergraduate degree.33 In this capacity, and reinforcing the point made to Morris, around the same time he was in correspondence with the Royal Commission’s secretary, M.W. Hodges. Their subject matter was a memorandum, ‘The Behavioural Sciences  –​Undergraduate Education’, on which Titmuss made a number of handwritten comments. So, for instance, after the sentence ‘The impact of scientific, technological and social factors on the role of the doctor and the social functions of medicine’ he inserted ‘The evolution of medical services in response to social problems and the changing nature of disease’. Similarly, after ‘The causes and relief of poverty, deprivation and handicap’ comes, in his untidy scrawl, ‘Levels of living in childhood, working age and old age’.34 By this point the Royal Commission’s work was coming to an end. In January 1968 Titmuss wrote to his friend Rosemary Stevens, an epidemiologist at the Brookings Institution in Washington. His research on what was to become The Gift Relationship had had to be put to one side because of LSE affairs (‘The Troubles’), and his work with the Royal Commission. He was looking forward to discussing the latter with her, and the report was ‘now in its last stages and we hope to sign it next month at the latest’.35 A few weeks later, when the report had been agreed, Todd told Titmuss how much he had enjoyed working with him, how he appreciated the amount of time Titmuss had spent on Commission activities, and that he was ‘especially grateful for the way you kept people in line on social aspects of our problems and your help in keeping a wary eye on statistics’.While the published outcome did not provide a complete solution to the issues the Commission had addressed, nonetheless he hoped that Titmuss agreed that it ‘represents our collective view of a very complex subject’.36 As we shall see, Titmuss was, in fact, sceptical about certain aspects of the Commission’s conclusions. First, though, a brief summary of its working methods and proposals. As of September 1965, the Commission had held over 100 meetings, and taken evidence from over 400 organisations and individuals (of these, especially sympathetic to Titmuss would have been Morris, Abel-​Smith, the Society of Social Medicine, and the Socialist Medical Association). Medical schools throughout Britain had been visited, while overseas trips included those to the USSR and the USA. Part

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of the Commission’s rationale was that, over the past century, ‘medicine has undergone tremendous development’, while the ‘pace of its advance shows no signs of slackening’. Medical education had become ‘a matter of particular public concern’, partly because gaining practical skills was bound up with ‘the provision of medical care through the health services of the nation’. This education was, essentially, achieved by students doing ‘apprenticeships’ in the field with leading practitioners.This was particularly true for postgraduate education, so that ‘the influence exerted by universities has been mainly felt at the undergraduate level’. This system worked well enough before the rise of scientific medicine, but was now inadequate.The first comprehensive inquiry into medical education had been the Goodenough Committee, which had reported in 1944. Dissatisfaction with medical education, already apparent by that point, had become widespread after 1945. Goodenough’s proposals, though, had only been partially implemented. Because of a combination of social and medical progress, caring for the sick had become a ‘national responsibility and the institution of the National Health Service must rank as one of the greatest social advances in our history’ –​sentiments close to Titmuss’s own heart. However, its creation involved the continuation of practices, not least in medical education, ‘not all of which were desirable’. The situation had been exacerbated by recurring economic crises, one consequence of which was the lack of progress in improving the material condition of hospitals and medical schools. Finally, the number of doctors being produced in Britain itself was ‘increasingly falling short of that necessary fully to maintain the National Health Service’.37 What was to be done? The report, seeking to address both future and present needs, had six main proposals. First, a fundamental underlying principle was that all doctors, including GPs, would be ‘specialists in particular aspects of medicine’, and of equal status. This implied changes both to career structure and, crucially, to postgraduate training. Consequently the universities, the professional colleges, and health departments should jointly establish ‘an agreed pattern of professional training for all specialists (including general practice)’. Second, undergraduate education should be firmly based in universities, and a university degree should be required for entry into the medical profession. The aim of undergraduate degrees, which should last five years, was ‘to produce not a finished doctor but a broadly educated man [sic] who can become a doctor by further training’. Third, the annual intake of medical schools should double by 1990 to address present, and future, shortfalls of doctors. Fourth, a reduction, by way of merger, was proposed in the number of London’s medical

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schools. The organisation of the capital’s teaching hospitals was especially problematic, but this was also part of a broader concern about NHS administrative structures. Fifth, the Commission had been asked to consider medical education in Britain in the wider context of assistance to developing countries, and proposals for further linkages between their respective medical schools were being made. Finally, the Commission had been asked to review medical education ‘in the light of national needs and resources’, and this had underpinned its work. So, for instance, medical advances were likely to make further demands on healthcare by extending life expectancy. Fundamentally, what was involved was ‘manpower and money, the former being at least as important as the latter’. The Commission’s proposals were, it acknowledged, expensive, but ‘within Britain’s national resources’. Both reform and expansion of medical education were ‘already overdue’, and ‘urgent action’ was required if Britain was to ‘maintain its position in the van of medical progress’.38 As Webster points out, the Commission’s optimism about finance was tempered by its recognition of possible economic constraints.The Treasury, predictably, was even more sceptical, and the Commission’s recommendations were only slowly implemented, and then ‘only in the most diluted form’.39 Nonetheless, change did occur.At the University of Oxford the medical curriculum was extensively revised in line with Todd’s recommendations, and, around the same time, Oxford’s first Chair in Psychiatry was created.40 Todd himself was keen to promote his Commission’s findings. He outlined these to a BMA meeting in October 1968, telling his audience that, for example, it was nowadays not reasonable for medical students to ‘remain ignorant of the behavioural sciences, whatever his [sic] future career is going to be’.41

Titmuss’s contribution Is it possible to assess Titmuss’s particular input to the Royal Commission? Reviewing the report, the psychiatrist Hugh Freeman suspected the ‘guiding hand of Professor Titmuss’ in a ‘passage which is likely to become a classic’. Taken from the section entitled ‘Future Medical and Social Needs’, the lines which had caught Freeman’s attention suggested that attitudes towards doctors, as towards members of other professions, are likely to move further still in the direction of regarding them as experts to be called in to prevent, investigate and remedy specific functional defects, rather than as members of an elite who

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are accorded a special status by virtue of their general background and education.42

Freeman did not make clear why he had singled out this passage as especially redolent of Titmuss, but it is a shrewd observation. Such views accorded with, for example, his critique of over-​powerful professional bodies going back to the early 1950s. In light of what we have already seen of Titmuss’s concerns about the reform of medical education, it is also worth dwelling on the notion of the ‘broadly educated’ undergraduate.The report, in dealing with undergraduate education, devoted five pages to the ‘behavioural sciences’. This noted the wide diversity of practice in teaching these subjects, by which was essentially meant psychology and sociology, with the latter being offered in only a few medical schools. Students had stressed the need for such subjects to Commission members with an emphasis on, in the case of psychology, ‘basic psychological functions’ in the context of ‘recognisable human behaviour’. Any ‘dogmatic exposition of psycho-​analytic concepts of the kind that has been encountered in some medical schools in the United States’, the report archly remarked, ‘has no place in scientifically-​oriented education’. Here we might recall Titmuss’s scepticism about an overemphasis on psychiatric concepts in social work training. Finding staff to teach behavioural sciences was, for various reasons, not straightforward. One was that ‘social science faculties’ had been placed under ‘considerable strain by the major part they have played in the general expansion of universities over the last ten years’. This had given them ‘more than enough problems of organisation and teaching within their own field without going out of their way to find others outside it’. Nonetheless, and this time discussing input from sociology and social administration, undergraduates should be provided early on with a ‘historical and comparative introduction to the medical needs of society and the role of the doctor and other health workers’. Later in their undergraduate careers, they should also be introduced to matters such as ‘the organisation and administration of medical care … possibly in association with students of social administration’.43 Royal Commission reports are the product of many hands, civil servants as well as Commission members. Nor was Titmuss the only advocate of social science instruction for medical students.The Society for Social Medicine, for example, argued in its evidence that the ‘actual and potential contribution which the behavioural sciences can make to a doctor’s understanding of the problems which confront him’ would be increased if, when training began, students were ‘introduced to the

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basic principles of sociological and psychological analysis’.To this end, topics such as ‘Social and Psychological Factors in the Aetiology of Disease’ should be studied.44 Nonetheless, it is hard not to see Titmuss as having a major input on the report’s claims about the behavioural sciences, and the pressure on social science departments. One part of the report almost certainly Titmuss’s work was the appendix ‘Specimen Syllabus in Social Factors Related to Medicine’. This was to be a component of the ‘Behavioural Sciences’ dimension of the medical undergraduate syllabus. It incorporated some of the amendments on the memorandum sent to the Commission’s secretary noted earlier, and was a distillation of a number of Titmuss’s particular concerns. Its principal themes were to be sociological concepts, demographic trends, the family, social stratification, social pathology, social medicine and the community, and health and social services and the study of social administration. The ‘Introduction’ set the tone, summarising the course’s content as The social history of medicine and medical care (this would not be an antiquarian’s course; it would begin with the 20th century and illuminate historical cause and effect). The impact of scientific, technological and social factors on the role of the doctor and the social functions of medicine. The evolution of medical services in response to social pressures and the changing nature of disease. Patterns of medical care organisation, the scope of medical specialities, and changing concepts of health and disease. The ethics of medicine, seen professionally and in the context of social change.45

Two aspects of the report’s proposals deserve further comment. The first involves the need to increase the supply of medical students, and to consider medical education in the context of British aid to developing countries.As noted, the issue of medical personnel had been addressed, in an ultimately unsatisfactory way, by the Willink Committee.Among its shortcomings were, as Webster puts it, the failure ‘to take realistic account of the demands of modern health services for trained medical personnel’.46 By the 1960s, meanwhile, the NHS was becoming increasingly reliant on staff from overseas. Webster observes that as early as the mid-​1950s, many parts of the hospital service would have been in trouble without workers from abroad, especially doctors from India and Pakistan. In 1958, for instance, it was estimated that, of the approximately 16,000 doctors working in hospitals in England and Wales, around 2,500 were from overseas.47

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Titmuss addressed this issue, and its implications, in an article published in 1967, that is while the Todd Commission was sitting. He noted that rich countries, for example Britain and America, were effectively importing skilled labour such as doctors. Such behaviour was ‘the height of national immorality’. Qualified staff were being ‘deliberately enticed’ from poorer countries to those which could easily afford to train their own staff. Thus the former not only lost skilled labour, they were also forced to pay ‘inflated rewards’ to those who remained. This was ‘foreign aid in reverse’. International measures were needed to protect poorer countries from being ‘denuded of scientific manpower’, while the rich countries should ‘spend more on education to satisfy their own needs –​and in a world more conscious of equality, to satisfy the needs of others’. Foreign aid could not be ‘better spent than when it is helping a nation to achieve its own welfare’.48 In the same year, Titmuss told the British National Conference on Social Welfare that, since 1949, the US had saved around £1,300  million by not having to educate and train workers in medicine, science, and engineering. Instead, such professionals had been imported. America was thus receiving more medical aid than it dispensed. Just as ‘we have recognised the injustice and the waste in the unrestricted free international movement of goods, material and capital, so we must now recognise the need for the richer countries of the world to take action to protect the poorer countries from being denuded of skilled manpower’. As the collection of newspaper cuttings in Titmuss’s papers attests, this speech was widely reported, in both Britain and the US.49 Titmuss was not alone in his concern. In 1968 Crossman, whose remit now included the NHS, recorded that the Cabinet ‘has a bad conscience about the way we are sucking the best skills out of the Commonwealth and keeping them here because it is in our interest to do so’.50 To complicate matters further, the 1960s saw a panic about the purported emigration of highly trained workers from Britain, particularly to North America –​the ‘brain drain’. It was claimed that British doctors, some motivated by hostility to the NHS, were part of this exodus. We noted earlier that the BMJ had raised this issue when the Todd Commission was set up. A number of studies were carried out, including one in Titmuss’s department by Abel-​Smith and Kathleen Gales. Funded by the Nuffield Provincial Hospitals Trust, one aim was to fill a need for a ‘factual study’ of the deployment of doctors, with ‘special attention to the alleged problem of “emigration” ’, in order to help in planning the future output of British medical schools. Abel-​ Smith and Gales found that between 1955 and 1960 some 2,900 British doctors had moved abroad. Around one third of these had moved to

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‘low-​income countries’, with the remainder going to Australia and New Zealand, Canada, and the United States. Clearly this was not an insignificant number, although it was difficult, as the authors pointed out, to factor for matters such as doctors returning to Britain.51 The second point about the Commission’s report relates to hospitals in London, and broader issues of medical administration, and teaching. In September 1967, Titmuss told Morris that the Royal Commission had ‘more or less agreed about the future structure and organisation of university teaching (and, of course, the work of other hospitals) in London and the South East’. Titmuss wanted to discuss these ‘quite radical and far-​reaching’ proposals with him. Although not spelt out in the report, its recommendations on hospitals would also ‘have some impact on community medicine –​at least in London and the South-​ East’. Any reorganisation of the capital’s hospitals was widely seen as a particularly knotty problem, but what Titmuss was driving at here was that ‘all these developments (and not just Seebohm) are revealing the weaknesses in public health departments: they add to the strength of the case for “an urgent and major inquiry” ’.52 The full implications of the latter part of this comment are returned to in Chapter 19, but here we note a Keppel Club meeting at which Titmuss expressed reservations about the possible implementation of the Commission’s proposals. He ‘wryly pointed out’ that the Commission would not have gone badly wrong had it simply reprinted the 1944 Goodenough Report on medical education. The Commission’s workings were then outlined, for instance that it required up to two days’ unpaid work a week for two and a half years. The ‘Ministerial courage’ in setting it up was commended, a jibe at Powell’s failure to do so. On its findings, the most controversial had been those concerning London, where ‘Custom and history confronted the logistics of science and technology –​it was frightening to contemplate the issues involved’.Titmuss was clearly not confident of progress here. He then addressed two final points. The first was ‘the Commission’s decision to regard the family physician as being vital in the future pattern of medical care’. As we have seen, this was a view to which Titmuss strongly subscribed. On teaching the behavioural sciences, it had been assumed that this could take place ‘in medical schools without the creation of such faculties within the medical schools’.There was, though, considerable doubt as to whether behavioural scientists wanted, or were equipped, to accept such a role. Overall, there was ‘a striking picture of disorganisation in the teaching of undergraduates and to some extent also of graduates. There is consensus about what should be taught, but is there the capacity to

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organise it?’The disorganisation inherent in medical schools, moreover, ‘may not be unrelated to the disorganisation of general practice’.53

Conclusion A number of the matters discussed in this chapter were longstanding concerns for Titmuss. That they remained so into the 1960s illustrates his contention that the ‘welfare state’ was an unfinished project, perpetually in need of revision. In the case of mental health, for instance, any move towards community care had to be met with increased resources, financial and human. Not to do so would simply shift the problem away from the institutions, possibly to the detriment of service users. As to ‘welfare professionals’ such as doctors, they had to become more aware of the totality of their clients’ circumstances. The patchy reform of mental healthcare and medical education, though, highlighted the complexity of the policy process, and the difficulties facing both campaigning voluntary organisations and official enquiries. Titmuss’s gloomy prognoses serve to highlight such issues. Notes 1 R.M. Titmuss, ‘Freedom to Thrive’, letter, The Times, 2 April 1959, p 11. 2 Titmuss, ‘Community Care as Challenge’, p 11. 3 V. Long, Destigmatising Mental Illness? Professional Politics and Public Education in Britain, 1870–​1970, Manchester, Manchester University Press, 2014, p 19. 4 TITMUSS/​2/​104, flyer for the Annual Conference of the National Association for Mental Health, ‘Mental Health is Everybody’s Business’, March 1961. 5 ‘End of Mental Hospitals is Forecast’, The Times, 10 March 1961, p 8. 6 J. Welshman, ‘Rhetoric and Reality: Community Care in England and Wales, 1948–​74’, in P. Bartlett and D. Wright (eds), Outside the Walls of the Asylum: The History of Care in the Community, 1750–​2000, London, The Athlone Press, 1999, p 211. 7 BPP, House of Commons Parliamentary Debates, 6 March 1961, cols 26–​7. 8 Welshman, ‘Rhetoric’, p 223. 9 LSE, LSE/​Central Filing Registry/​514/​1/​K, letter, 2 May 1960, RMT to Caine. 10 Richard M. Titmuss, ‘Care –​or Cant?’, The Spectator, 17 March 1961, pp 354–​5. The speech was reprinted in H.  Freeman and J.  Farndale (eds), Trends in the Mental Health Services, Oxford, Pergamon Press, 1963 as ‘Community Care –​Fact or Fiction’; and in Commitment to Welfare as ‘Community Care: Fact or Fiction?’ 11 Long, Destigmatising, p 11. 12 TITMUSS/​2/​104, letter, 13 March 1961, Appleby to RMT. 13 TITMUSS/​2/​104, letter, 5 May 1961, Winner to RMT. 14 See, for example, the clippings in TITMUSS/​2/​104, The Times, 11 March 1961, and the Birmingham Post, 11 March 1961. 15 ‘Everybody’s Business’, The Lancet, 18 March 1961, p 609. 16 BPP, House of Commons Parliamentary Debates, 20 March 1961. 17 BPP, House of Lords Debates, 26 April 1961, cols 870–​72.

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RICHARD TITMUSS 18 Titmuss, ‘Role of the Family Doctor Today in the Context of Britain’s Social Services’, The Lancet, 1965, I, p 1. Reprinted in Commitment to Welfare. 19 Welshman, ‘Rhetoric’, p 223. 20 TITMUSS/​7/​73, letters, 10 February 1965, Levy to RMT, and 11 February 1965, RMT to Levy. 21 TITMUSS/​7/​73, letters, 29 March 1965, Registrar, Royal College of Physicians, to RMT, and 1 April 1965, RMT to Registrar. 22 ‘Commission Set Up on Medical Education: Lord Todd to Be Chairman’, The Times, 30 June 1965, p 12. 23 TITMUSS/​7/​10, letters, 14 July and 23 July 1965, John Hewitt, Private Secretary to the Prime Minister, to RMT. 24 TITMUSS/​6/​702, letter, 9 August 1965, RMT to Miller, Syracuse University. 25 TITMUSS/​6/​702, letter, 19 October 1965, RMT to Miller. 26 ‘Commission on Education’, BMJ, II, 1965, pp 57–​8. 27 C. Webster, The Health Services since the War: Volume II, Government and Health Care,The National Health Service 1958–​1979, London, HMSO, 1996, pp 283–​96. 28 TITMUSS/​7/​10, letter, 1 November 1966, RMT to Todd. 29 J. Fry, ‘The Keppel Club (1952–​74): Lessons from the Past and for the Future’, BMJ, 1991, II, pp 1596–​8. 30 TITMUSS/​7/​10, Minutes of the 93rd Meeting of the Keppel Club, 21 January 1966. 31 TITMUSS/​7/​10, memorandum, 24 February 1966, Abel-​Smith to RMT. 32 TITMUSS/​7/​10, letter, 30 November 1967, RMT to Morris. 33 Webster, The Health Services since the War: Volume II, p 289. 34 TITMUSS/​7/​10, letter, 18 December 1967, RMT to Hodges attaching memorandum ‘The Behavioural Sciences –​Undergraduate Education’ with handwritten amendments, pp 2, 4. 35 TITMUSS/​AO, letter, 16 January 1968, RMT to Stevens. 36 TITMUSS/​7/​10, letter, 2 February 1968, Todd to RMT. 37 BPP, 1967–​68, Report of the Royal Commission on Medical Education: Cmnd.3569, pp 19–​22 and Appendix 1 for witnesses. 38 Ibid, pp 22–​6. 39 Webster, The Health Services since the War: Volume II, p 294. 40 C. Webster, ‘Medicine’, in B.  Harrison (ed), The History of the University of Oxford:  Volume VIII, The Twentieth Century, Oxford, Oxford University Press, 1994, pp 342–​3. I owe the point about the expansion of teaching psychiatry to Professor John Hall. 41 Lord Todd, ‘The Doctor in a Changing World’, BMJ, IV, 1968, p 209. 42 H. Freeman, ‘The Royal Commission on Medical Education’, Social Policy and Administration, 2, 3, 1968, p 200.The quote comes from p 30 of the Commission’s report. 43 Report of the Royal Commission on Medical Education, pp 104–​8. 44 TITMUSS/​7/​10, copy of Society for Social Medicine, Evidence Submitted to the Royal Commission on Medical Education, London, BMA, 1966, pp 159–​60. 45 Report of the Royal Commission on Medical Education, Appendix 11. 46 C.Webster, The Health Services since the War: Volume I, Problems of Health Care.The National Health Service before 1957, London, HMSO, 1988, p 256. 47 Webster, The Health Services since the War: Volume II, p 18 and Appendix 3.29. For a long-​term overview, see S. Snow and E. Jones, ‘Immigration and the National

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48 49 50

51

52 53

Health Service: Putting History to the Forefront’, available from the History and Policy website as a policy paper. R.M. Titmuss, ‘Trading in Human Capital’, Science Journal, 3, 6, June 1967, p 3. TITMUSS/​2/​218, the example used here is from ‘Significant and Alarming Facts about the Brain Drain’, Sheffield Morning Telegraph, 11 April 1967. R. Crossman, The Diaries of a Cabinet Minister: Volume III, Secretary of State for the Social Services, London, Hamish Hamilton/​Jonathan Cape, 1977, entry for 4 October 1968. B. Abel-​Smith and K. Gales, British Doctors at Home and Abroad: Occasional Papers on Social Administration No 8, Welwyn, Hertfordshire, The Codicote Press, 1964, pp 6, 56, table 26, 58. TITMUSS/​7/​10, letter, 19 September 1967, RMT to Morris (emphasis in the original). TITMUSS/​7/​10, Minutes of the 111th Meeting of the Keppel Club, 24 May 1968, pp 2–​3, ‘Report of the Royal Commission on Medical Education:  An Introduction’.

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18 Mauritius, Tanganyika (Tanzania), and Israel Introduction Titmuss actively engaged with certain developing countries, partly motivated by his support for racial equality. He also acted as an advisor to overseas academic institutions. So, for example, in 1963 he sought leave to act as external examiner for a new diploma course in Social Administration at Makerere University College in Uganda. This, he told Sydney Caine, was being developed to meet ‘East African needs’. Where possible, such initiatives should be supported, not least because of the LSE’s own interests in ‘undergraduate and graduate courses in Social Administration and Community Development for students from overseas’.1 More broadly, the School had long been involved with the development of the social sciences in what were, initially, British colonies.2 Sheard, meanwhile, points to the significant number of African politicians who took their experiences at the LSE back to their own countries.3 In this chapter we examine Titmuss’s engagement with Mauritius, Tanganyika (Tanzania),4 and Israel. In the case of the first two,Titmuss was commissioned by their governments to suggest ways forward for their welfare systems.Although Titmuss was the lead figure, it would appear that nearly all the heavy lifting, in terms of writing and research, was done by Abel-​Smith and, in the case of Mauritius, Tony Lynes. In part, this resulted from Titmuss’s indifferent health, although his willingness to delegate to a significant degree likewise needs to be taken into account.5 Israel was different. There Titmuss was involved more through talks and lectures, and the establishment of what were to be important professional and personal relationships.This involvement has, though, been little commented upon.

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Mauritius In early 1959 Titmuss was invited by the government of Mauritius, a group of islands in the Indian Ocean and at this point still a British colony, to report on ‘the provisions to be made for social security, bearing in mind the resources of the territory and the needs of its people’.The report, co-​authored with Abel-​Smith and Lynes, appeared in 1961. In his preamble, Titmuss remarked that he had asked that his commission’s terms of reference be ‘interpreted widely enough to allow me to consider the whole field of social security, health and welfare’. This, along with his request that Abel-​Smith and Lynes be involved, had been agreed. Titmuss then undertook discussions with Mauritian ministers visiting London. Due to illness, he was unable to visit Mauritius in August 1959, but Abel-​Smith and Lynes did so in order to ‘undertake initial investigations’. They brought back ‘voluminous notes and original matter’ which Titmuss supplemented by way of further interviews held in London later that year. A draft report had been drawn up, and a visit to Mauritius planned for March 1960. Two cyclones, Alix and Carol, had caused immense damage, and when Titmuss, Abel-​Smith, and Lynes arrived in the aftermath of Carol they found the country ‘overwhelmed by social and economic problems demanding immediate action’. This threw into sharp focus some the ‘fundamental issues of social policy which we had already identified’, so lending an urgency to their work. A further consequence, though, was that the report being presented was ‘not as comprehensive and thorough as I had planned’. Nonetheless, the ‘facts presented here are sufficiently adequate to provide a valid basis for the conclusions reached’.6 Titmuss supplemented the information in the report in a letter to Caine in late 1959. He acknowledged Lynes and Abel-​Smith’s role in setting up ‘certain statistical studies’. A draft of the report’s key sections would be in place by the end of January 1960. Since his Easter 1960 trip had been mooted, a new development had taken place in that they had learned of plans for ‘an economic survey mission under the chairmanship of Professor James Meade’. Clearly, his own report and Meade’s ‘should be coordinated on a number of important issues’, for example population growth. Meade and Titmuss had agreed to work in concert, and that their respective teams should meet in Mauritius to further co-​ordinate research. However, Mauritian ministers and officials wanted to see Titmuss and Abel-​Smith before Meade’s team arrived ‘in order to clear out of the way some of the more specific social welfare problems’. Titmuss thus sought approval that he and Abel-​Smith be absent from the School for the last three weeks of Easter term. Caine

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responded positively, so enabling Titmuss and Abel-​Smith to reach Mauritius by early March.7 James Meade was an eminent economist (he later won the Nobel Prize), formerly of the LSE, now at Cambridge. He had been active in League of Nations circles prior to 1939, before serving in the wartime Cabinet Office. It is thus likely that he and Titmuss had been acquainted for some time. Meade’s findings were also published in 1961.8 Reflecting on his time in Mauritius shortly afterwards, Meade noted that concurrently with his own survey Titmuss was working on how the Mauritian government ‘might introduce a social security system’. Meade remarked, presumably tongue in cheek, that Mauritius had had a challenging time in the first three months of 1960, being ‘visited not only by the two cyclones Alix and Carol but also by the two Professors Titmuss and Meade’. The impact of the former had been devastating, but ‘what about the relationships between the two professors?’ Largely for demographic reasons, it would be a considerable achievement if Mauritius could find work for its growing population. High wages, and high taxation, should be avoided. But if a ‘moderate element of social security can be used as a means of establishing a really effective policy of wage restraint, this is a system which makes very good sense in Mauritian conditions’.This was not, though,‘the whole of the Titmuss story’. Public assistance administration was already breaking down, so an ‘extensive recasting of social security arrangements was … in any case essential’. There was also the opportunity to use social security ‘in a way which helps to establish the pattern of a three-​child family instead of making the very large family a financially paying proposition’, as was the tendency under existing arrangements. All this had been dealt with in Titmuss’s report.9 What did the latter conclude? The Titmuss team was convinced that improving social services, and restraining population growth, were inextricably linked, as flagged up in the report’s title, Social Policies and Population Growth in Mauritius. So, for instance, in the 30  years up to 1952 population had increased by one third. While this period saw advances in welfare provision, these ‘in no way measured up to the challenge of this trend, nor took cognisance of its implications for the future’. The proposals being made would demand sacrifices by the population, and ‘political courage of the first order, dynamic leadership and honest administration’ by the government. Before the introduction of any new benefits, an official family planning service must be established, backed up by measures to ‘support and strengthen family life’, and steps taken to improve a ‘reasonably high level of employment’. Family planning was acknowledged to be controversial,

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given the country’s significant Roman Catholic population. But the report’s proposals were a total package.The authors could not ‘approve any action, on political, religious or other grounds, which accepted only some of our proposals for legislation’. Were this to happen, ‘we would prefer the whole of our Report to be rejected’. It was stressed, though, that family planning was, in itself, of little use without the ‘most vigorous economic and social planning’. The ultimate aim was the establishment of the three-​child family as the norm –​the point alluded to by Meade.10 The report then went on to explain the plan’s ‘second stage’, the introduction of social insurance. Provision for sickness and unemployment had ‘an important part to play in building a stronger and more secure family life’, which had to be backed up by a ‘reasonably high level of employment’. Moreover, a ‘work test’ should be employed to separate the ‘genuinely unemployed … from the work-​shy’.This stark, startling, statement is in marked contrast to the hostility of Titmuss and his colleagues to any such discrimination in Britain. In Mauritius, however, the ‘whole structure’ of both unemployment and sickness benefits depended on ‘the assumption that the work test can be made effective’. Ultimately, though, unemployment benefit was merely a palliative.The real solution lay in the creation of more work. Concluding, it was noted that the investigation’s original terms of reference had not specifically requested that ‘the problem of population growth’ be considered. But account had to be taken of population trends, since measures to improve living standards ‘cannot ignore the fact that the problem of poverty in the island is dominated by the poverty of large families’. So, overall, the authors could ‘see no alternative’ to the proposed course of action.11 The report had a lasting effect. As his final illness took hold, Michael Young told Titmuss that he had just returned from Mauritius, noting too that he had previously written to him about ‘the impact you had made on the island, despite all its rascally politics’.12 The High Commissioner for Mauritius attended Titmuss’s memorial service, and the Prime Minister, Sir Seewoosagur Ramgoolam, was one of the many who sent Kay a letter of condolence.13 As James Midgley confirms, the report was both well-​received by the Mauritian government and widely read by British social policy scholars. Its recommendations became the basis of the Mauritian welfare system after independence in 1968, and, Midgley concludes, its ‘influence is still felt today’.14 Titmuss himself was keen to spread his findings more widely. In the early 1960s, for example, he gave an address on ‘Medical Ethics and Social Change (with Special Reference to Mauritius)’.This noted the contrast between how ‘scientific medicine’ had developed in the West

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over a long period within a tradition of ‘professional ethics’, and the ‘comparative ethical vacuum’ in which it was developing in contemporary Africa and Asia. Rapid medical advances were occurring ahead of the ‘slow growth of professional standards in medical behaviour and attitudes towards patients’. He had seen such an ethical vacuum in Mauritius. In such societies doctors were not an identifiable professional group. Rather, outside of hospitals they worked in isolation and as ‘entrepreneurs’. As such, they had not developed a ‘professional self-i​ mage’.15 Notwithstanding his concerns about professional behaviour in more ‘advanced countries’, this was a perceptive point about cultural and historical differences.

Tanganyika Tanganyika, independent since 1961, was an important East African nation. As with Mauritius, in the preamble to the report which he and his ‘Medical Survey Committee’ produced,Titmuss recorded how his involvement had come about. In July 1961 the African Medical and Research Foundation (AMRF) had approached him, along with Professor George Macdonald and Dr Arthur Williams, both of the LSHTM and both authorities on East Africa. The proposed survey’s brief was to ‘examine the present organization of medical services in Tanganyika, bearing in mind the desirability of close integration of government and voluntary agencies’. Recommendations were sought on matters such as the expansion of curative services, staffing needs, and how such staff might be ‘trained locally, bearing in mind that it may not in every case be either necessary or desirable to insist upon United Kingdom qualifications’ while maintaining ‘reasonable standards’. Prior commitments prevented this group from visiting Tanganyika before the end of 1961, but in the meantime Titmuss had suggested that Abel-​ Smith and Christopher Wood, members both of the Keppel Club and of LSHTM, make a preliminary, fact-​finding visit. This took place in late summer 1961.16 As Titmuss later told a Tanganyikan minister, by this point the team had already held several meetings in London.17 Titmuss then recorded the work Abel-​Smith and Wood had undertaken, as a result of which it was agreed that they, too, should be members of the Medical Survey Committee (and hence co-​authors of the report). In early 1962, meanwhile, Macdonald spent four weeks in the country, travelling extensively. This was followed by a visit, in late summer 1962, of the whole committee.While no formal evidence was received, wide-​ranging discussions took place. During this trip the committee was able to call upon Rosemary Stevens for advice.

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Stevens, an old friend of Titmuss’s, was based at the Yale Department of Epidemiology and Public Health, and was in Tanganyika around the time of the committee’s visit. Such was her involvement that Stevens later attended most of the committee’s London meetings. Given the committee’s small size, much of the discussion and drafting was ‘done by informal contacts between one or two members’. Individual drafts of sections of the report were, though, discussed collectively. A broad view had been taken of the phrase ‘medical services’, and while the original brief had been to look at the next five years, it was decided to ‘think broadly in terms of a twenty-​year period of development’. Factors such as ‘the rate of economic and educational advance’ justified this approach. On a very Titmuss-​like note, for no future period had a blueprint been produced.The ‘expert’ had his limitations, for he was ‘after all only a servant, and should always remember how little he really knows’.What the committee had sought to do, therefore, was ‘to recommend stages of development over the next two decades, and to show how progress in one sector depends on progress in other sectors’. The rate at which healthcare developed, though, was ‘largely a question of political priorities upon which we can offer little guidance’.18 Producing the report was not unproblematic, with Tanganyikan officials intervening at various points. Nonetheless, the reception was generally positive. In March 1963, for instance, Saidi Maswanya, the Minister of Health, wrote to Lord Twining (Lord Twining of Tanganyika and Godalming) in the latter’s capacity as head of the AMRF.The report had not, as yet, received detailed examination. But it was evident that ‘it will be of very great value to the Ministry in the formulation of its Development Plans’. Maswanya was keen for the report’s publication, ‘not only in order to give it wide circulation among interested persons in this country, but because it will be of undoubted value to medical planners in other countries at a similar state of development’.19 In Britain, the AMRF subsidised the report, and extracts were printed in the journal with which Titmuss had close contacts, Medical Care.20 Tanganyika provided a sympathetic study for Titmuss, and he made concerted efforts to support the country in various ways. So, for instance, in late 1963 he recorded a meeting with one of the trustees of Dartington Hall, Peter Sutcliffe. Dartington Hall was, and remains, a charitable organisation with wide interests. Titmuss had promised Sutcliffe an advance copy of the Tanganyika report. The charity had been investing in ‘certain community development activities’ in the country, and Sutcliffe was due to make a further visit in mid-​1964. It was possible that this could coincide with Titmuss’s own visit in March.Titmuss concluded that he might approach the trustees at some

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future point ‘for financial assistance towards supporting Fellowships for Tanganyikans to come to London and other specific purposes’.21 Tanganyika itself was led, between 1961 and 1985, by the charismatic Julius Nyerere, much admired by the international liberal left. He had received part of his education at the University of Edinburgh where he joined the local Fabian Society. He was later to speak, in 1959, at the founding meeting of the Anti-​Apartheid Movement, of which Titmuss was a supporter. Like Titmuss, Nyerere came across as unassuming and modest. He was committed to his people’s welfare, and to building a particular form of African socialism.22 Cranford Pratt highlights the ‘ethical foundation’ of Nyerere’s ideas, involving ‘an affirmation of the fundamental equality of all humankind and a commitment to the building of social, economic and political institutions which would reflect and ensure this equality’. Nyerere’s commitment to ‘equality and to community’ distinguished him from ‘Western liberalism, with its primary emphasis on individual liberty and its much weaker attention to equality and fraternity’.23 It is not being suggested that Titmuss would have agreed with all of Nyerere’s ideas, or vice versa. But there was a compatibility here, as well as an intellectual challenge. In summer 1962,Titmuss told an American friend, Martin Rein, that he was shortly to leave for Tanganyika. The research being undertaken there had ‘rather suddenly entered a new and exciting phase’. It was concerned with the ‘development of health and welfare functions in a country (almost as large as Western Europe) with a population of 10 million and a health budget of just under $6m’. His team was studying ‘not only policy questions but the categories of staff and their training needs appropriate, financially and sociologically, to the circumstances of Tanganyika’. Consequently, ‘we have to begin by rejecting Western professional models’.24 This shows Titmuss’s willingness to be intellectually flexible although, of course, he was already sceptical about ‘Western professional models’. Tanganyika clearly had an impact. In September 1962 he wrote to Lord Twining to express, on behalf of the Medical Survey team, now returned to England, ‘our great appreciation of the Foundation’s help’. All team members had surely benefited from ‘this experience and the opportunities we have been given of studying first hand the medical and administrative problems of Tanganyika’. On a personal note,Titmuss had ‘found it an absorbing responsibility’.25 The report noted that many medical problems were ‘largely dictated’ by Tanganyika’s ‘geographical and demographic characteristics’. So, for instance, while urban population density was high, in the countryside it was very low. In the latter, providing even territorial healthcare coverage

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faced ‘formidable physical difficulties’. But such areas were important. Their populations faced ‘special health risks’, and so required protection as much as, or even more than, those in towns and cities. There was thus a need for ‘far-​reaching improvements in the health services’, although this had to be carried out with a realistic sense of what the economy could deliver. Hence the ‘main emphasis’ was on the ‘need for the balanced development of the health services within an overall national plan’. In the first instance, an administrative structure should be set up involving, for example, the ‘establishment of a network of health centres and health clinics’. Similarly, hospital provision should be rationalised and coordinated. As in Mauritius, family planning should be encouraged and, in due course, a scheme of health insurance gradually introduced.26 The Tanganyika Report paid due attention to medical education. Over the next 20 years the number of medical practitioners should be tripled. Training should take place in Tanganyika itself, and ‘stress the needs of rural areas, through practical work in the field’. In the first instance, a new education programme was recommended, to commence in 1963. Producing the required number of doctors would take time so, in the interim, the number of less qualified ‘medical aids’ should be dramatically increased, by a factor of five over the coming 20 years. These practitioners should be given responsible positions within health centres, and within the new administrative structures generally. There should also be a new post of maternity aid whose numbers, like those of medical aids, should rise to 2,000 over the next two decades. More nurses and support staff, such as laboratory assistants, were likewise required. Finally, there was a need for more psychiatric staff, both in mental hospitals and in the community.27 This was an ambitious programme, but it appears to have had an impact. As David Piachaud notes, in the latter half of the 1960s Nyerere was articulating his vision of socialism, and this included concentrating rural populations ‘so that social services such as schools and health centres could be based’ in these villages. Piachaud argues that this ‘accorded with the proposals of visiting UK Fabian advisers’, namely Titmuss and Abel-​Smith.28 In early 1968, meanwhile, Titmuss, accompanied by Kay, again visited what was now Tanzania, acting as external examiner for the ‘Behavioral Sciences’ component of a recently introduced course in medicine, and participating in a conference on family planning.29 Prior to his trip, Titmuss sought a meeting with Nyerere, as he was hoping to ‘bring myself up to date with recent economic and social policy developments’. From what he heard from various sources, including African students, it seemed clear that ‘the most exciting social policy

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developments are today happening in your country’.30 The meeting duly took place, with Titmuss telling a correspondent that his trip had been ‘most stimulating’, and that he had brought back ‘a complete collection of the Arusha Declaration and other recent papers by President Nyerere’.31 The declaration was a major statement about the aims of ‘African Socialism’, and included the aspiration to eliminate poverty, disease, and ignorance.At the family planning meeting,Titmuss told delegates that he ‘had not come to Tanzania to pose as an expert on another country’s problems nor to act as a propagandist for any method of contraception’. Rather, the seminar’s aim was to ‘examine the choices for the whole country in the light of its own aspirations and its own economic circumstances’.The issues raised involved collective and individual choices about future population trends, and about the number, and spacing, of children born to individual families.32 On a (presumably) lighter note,Titmuss and Kay also spent two nights under canvas at the Mikumi Wildlife Camp.33 Although difficult to show direct cause and effect, it is notable that Titmuss told Caine, early in 1963, that his department had experienced a notable surge in overseas interest in the social work course, including applicants from Mauritius and Tanganyika.34 Titmuss’s African experience was also officially recognised in that, in 1965, he joined the Consultative Panel for Social Development at the Ministry of Overseas Development. The panel’s remit was to provide the minister with ‘a loose but formal link whereby she and her officials may consult those who, either in the academic world, in the leadership of voluntary organisations or as individuals, are taking part in social development, as it might apply to developing countries’.35 Titmuss retained membership into the 1970s. As an official made clear, while Titmuss had a poor attendance record, nonetheless the department valued its LSE connection. He hoped, too, that ‘we may continue to consult you on social development matters as the need arises’. Titmuss agreed to this, stressing his continuing commitment to overseas development, and to the ‘training of students from underdeveloped countries’.36 There was a final twist to Titmuss’s relationship with Tanzania. After his memorial service, Kay wrote to one of the speakers,Wilbur Cohen. It had transpired while talking with Crossman ‘that he had known nothing of [Titmuss’s] interest in Tanzania and his work with Nyerere, so perhaps people present heard from you an aspect of Richard’s life hitherto unknown to them also’.37 In fact, the typescript of Cohen’s speech makes no mention of Tanzania. But what is important is the apparent lack of knowledge about part of Titmuss’s work which had been revealed. It also reinforces the idea of Titmuss having a good

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working relationship with Nyerere. He, too, wrote to Kay on Titmuss’s death.38

Israel: first contact In March 1963, Titmuss told Caine that he had been invited to Israel, where he was to lecture at the Hebrew University, meet with the country’s president, spend time at two research institutes, and ‘see something of recent developments in the social service field’.39 This invitation had been initiated in 1962 by Itzhak Kanev, an Israeli social policy expert. Like many of his colleagues, he was left-​wing, and an admirer of the achievements of Britain’s post-​war Labour governments.40 In spring 1959, Kanev told Titmuss that he had recently met his friend Tom Simey, to whom he had stressed the ‘extent your research methods had assisted me in my own work’. He would therefore like to invite Titmuss to Israel, not least because the country’s climate would help with his lung problems (Titmuss’s late 1950s bout of tuberculosis, again).41 This was the first of a series of invitations, stymied on occasion by ill health. More immediately,Titmuss arranged for Kanev to visit the LSE in late 1959. As he told Caine, Kanev was an ‘interesting man’ with extensive experience of ‘social policy questions in Israel since 1923’.42 Kanev had thus been active since shortly after the creation, in the early 1920s, of Britain’s Palestine Mandate, and then into the founding of Israel in 1948. The director arranged funding for Kanev to visit the School, where among his activities it was proposed that he take classes on social integration and social policy in Israel.43 Kanev was to maintain his links with Titmuss’s department, later being, for instance, part of an international study on comparative aspects of poverty.44 It is significant, too, that Abel-​Smith had recently worked on the Israeli social services, and had visited the country in the late 1940s.45 He would undoubtedly have shared his insights with Titmuss. Israel had a particular vision of itself. As one contemporary commentator remarked, the ‘concern of Israelis with a socially just and emotionally secure life for all the country’s residents expresses itself in prodigious efforts to provide needed social services, even at great sacrifice’.This was a task ‘unique in the history of social welfare, facing problems astronomic in proportion’.46 Titmuss shared this sense of Israel as a society brimming with opportunity, although he was presumably aware, too, of the shortcomings of the incipient welfare system. As Abraham Doron points out, exactly ten years after Britain abolished the remnants of the Poor Law, the left-​leaning Israeli government effectively introduced its own version. Nonetheless, it was during the

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1960s, when Titmuss actually visited the country, that the foundations of the Israeli welfare state were laid.47 In 1962 Kanev approached the president of the Hebrew University in Jerusalem, Eliahu Eilat, and Israel Katz, another important figure in Israeli social policy through, especially, his leadership of the Paul Baerwald School of Social Work, about a possible Titmuss visit the following spring.48 The School of Social Work had been set up, in 1958, as part of the Hebrew University.49 The university later established the Richard Titmuss Memorial Lecture. In 1986, this was given by Oakley, who found Israel a ‘shockingly uncomfortable place’, and her visit was clearly one of the less happy episodes in her academic career.50 Titmuss became especially friendly with Kanev and Katz (he and his wife stayed at Titmuss’s home when in London), while also impressing his Israeli hosts more generally. So, for instance, he was sent seeds for his garden and, each New Year, a box of Jaffa oranges.51 Like Kanev, Katz was to be an official visitor to Titmuss’s department, in his case in late 1968, a visit involving a farcical internal School correspondence over whether he was entitled to Senior Common Room status.52 Titmuss visited Israel four times in the 1960s, and had extensive contact with Israeli government officials. He was impressed by what he saw, telling a conference in Jerusalem in 1967 that he was ‘an admirer and friend of Israel’.53 Given the state of the region’s politics (the Six Day War would break out within a few weeks) this was a notable assertion of Titmuss’s position. In what follows, we look at what he had to say in Israel, and what sort of advice he gave to those Israelis involved with social welfare. Titmuss’s first trip came in 1963, although (again) not without preceding health concerns.54 It was eagerly anticipated. Hilda Kahn, a senior official in the Ministry of Social Welfare, told Robin Huws Jones of the National Institute for Social Work Training a few weeks before Titmuss’s arrival that you ‘must certainly know that he is quite a legend and my colleagues, particularly the professionals amongst them, are quite excited at the prospect of meeting him personally’.55 Shortly afterwards, Kahn wrote to Titmuss himself. A meeting had been arranged at her Ministry to be attended by various departmental heads.Those attending would like to ‘use the opportunity of having you with us to ventilate one of the problems … very much on our mind at present’, namely the ‘place of specialised welfare services within the framework of the general family welfare service’. Alternatively, he might like to talk on the ‘principles of social administration’.56 Titmuss was clearly highly regarded in Israel even before he set foot in the country. His trip, on which he was accompanied by Kay, included time in both Jerusalem

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and Tel Aviv, with excursions to historic sites such as Nazareth, and lectures at various venues, for instance the Afro-​Asian Institute.57 Kanev went out of his way to publicise Titmuss’s visit. In a Jerusalem Post article, he told readers that a ‘distinguished visitor’ was about to arrive for a fortnight’s stay. Titmuss had devoted his life to ‘the study of the causes of poverty’, was to speak at various institutions, and to meet with ‘sociologists and staff at the Paul Baerwald School for Social Work’. His address to the Afro-​Asian Institute, meanwhile, was to be on ‘social policy in the new countries’.58 Titmuss received further publicity in the Jerusalem Post during his visit when Dr Abraham Marcus, under the title ‘Prof Titmuss Attacks Market System in Medical Services: The Doctors’ Dilemma’, summarised an article by Titmuss which had recently appeared in the journal Medical Care.59 Marcus was, in fact, this publication’s editor, and the article in question, ‘Ethics and Economics of Medical Care’, was, as we shall see in Chapter 27, one of the early sources of The Gift Relationship. At the Paul Baerwald School, Titmuss acknowledged the ‘double honour’ of being asked to lecture at the university, and at the School. Like others in the British academic world, he had ‘watched with admiration’ the latter’s progress. While his department had just celebrated its fiftieth anniversary, the Paul Baerwald School was just five years old. This could be an advantage in that ‘younger’ institutions could be more flexible, and less concerned with specialisms. This led into the central part of Titmuss’s address, which dealt, in familiar terms, with what he saw as the resistance of the older professions in Britain, notably medicine and law, to change.60 The Afro-​Asian Institute for Labor Studies and Cooperation, meanwhile, the venue for another Titmuss speech, had been set up jointly by the Israeli Histadrut (the General Federation of Labour, an important player in welfare policy), and its American counterpart, the AFL-​CIO. Its aim was to ‘train Asian and African students to assume positions of leadership in their native labor movements’. The programme started in January 1963, and the majority of the attendees came from anglophone East Africa. All this was part of a broader strategy to win hearts and minds in developing countries perceived to be facing similar issues as Israel, and to which the latter could provide assistance.61 Given that Titmuss was working on Tanganyika at the time of his visit, and that Tanganyika was a beneficiary of Israeli support, all this tied neatly together. Titmuss’s first encounter with Israel was mutually beneficial. Shortly after his return, he told an American colleague that he had ‘just come back from a lecturing visit to Israel where I saw a good deal of the problems of medical care organisation’. Israel was ‘an exciting country to

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visit’, and he had met ‘a large number of most interesting and thoughtful doctors’.62 Kanev told him that the trip had ‘certainly been of great benefit’.Titmuss’s lectures, along with the ‘advice and guidance’ he had given ‘so unstintingly’ in individual discussions, including with Cabinet Ministers, had been of ‘lasting value’. Kanev also noted that the ‘Seminar on Social Policy’, planned for 1964 and for which Titmuss was the lead figure, ‘will no doubt greatly assist us in the training of social workers, and it will be of help to our social insurance institutions and public health and family doctors’.63 The following day, Kanev wrote again.Titmuss’s visit had been a ‘ray of light in one of the dark moments in the history of our small country’. Israel was beset by numerous problems, including absorbing immigrants ‘from the four corners of the earth’.The international situation, moreover, was disturbing. Egypt’s President Nasser was the new Hitler, while the USA and the USSR conducted their Middle East policy in a manner reminiscent of the 1930s –​the superpowers were, that is, appeasing Nasser. Kanev concluded by asking: ‘Where is the civilized world? Why does it keep silent? These questions constantly gnaw at our brain’.64 Kanev clearly saw Titmuss as a sympathetic figure to whom he could unburden himself. But did he also see Titmuss as a person of influence, who might help shape British opinion in Israel’s favour? Kanev certainly had a high opinion of Titmuss and his colleagues. Following the receipt of a copy of Titmuss’s talk celebrating the fiftieth anniversary of his department, Kanev told him that this jubilee should be celebrated worldwide, ‘by all those who have profited so much by advice and assistance from its scientists and inspired teachers’. The aid extended unreservedly to ‘everyone in need of it in the fields of social policy and all problems connected with humanitarian achievement, is an outstanding achievement of which you can all be proud’.65 In autumn 1963, meanwhile, Titmuss was contacted by an Israeli Ministry of Finance official. The significance here is less the nature of the enquiry –​whether to introduce differential rates of income tax –​ and more the esteem in which Titmuss was held, and the way Israel saw itself. Recent change had brought about concentrations of income in certain ‘non-​productive’ sectors of the economy, to the benefit of a limited number of people. Such a ‘social development’ was ‘counter to the social outlook of the leadership of the State’ which saw as its ‘basic task the creation of a working nation based on social principles, among them preventing of the creation of wide social differentials’.66 Titmuss had clearly been identified as sympathetic to such ‘social principles’. The official, now working for the Prime Minister, and a Ministry of Finance colleague, visited London shortly thereafter to pursue the

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differential taxation rates question.They subsequently wrote thanking Titmuss ‘for the very kind assistance and help you gave us during our stay’. The ‘help you extended us and the time you devoted to us’ had undoubtedly ‘made our trip most profitable’.They would be reporting ‘the contents of our discussions with you’ to their ministers. On a more domestic note, they also expressed their ‘appreciation to Mrs Titmuss and Ann for the very kind hospitality accorded to us’.67

Keeping in touch: the Jerusalem seminar and after Titmuss’s second trip to Israel came in autumn 1964, again accompanied by Kay. Before their departure, he was asked by a United Nations official if he would be prepared to have his visit included in a UN scheme ‘for short term assignments of social welfare experts’, with the organisation contributing towards his travel costs.Titmuss agreed.68 Titmuss and Kay’s itinerary embraced academic meetings and social outings, for example a visit to Galilee with Israel and Miriam Katz.69 On the more formal side, the Director of the National Insurance Institute (responsible for pensions and other medical and welfare benefits) sought a meeting to discuss, especially, hospital insurance as the first step towards a comprehensive health insurance scheme, and how to effect the transition from a flat-​rate to a graduated pension scheme.70 Titmuss was also a guest at the home of Zalman Aran, Minister for Education and Culture, later sending him copies of the brochures pertaining to courses available at the LSE’s Department of Social Administration.71 However the main event was Titmuss’s speech to the meeting on the future of social services in Israel, the seminar alluded to by Kanev the previous year.This took place over four days at the Hebrew University, with an opening address by Prime Minister Levi Eshkol. He was followed by Titmuss, the only non-​Israeli to address the meeting.72 On its conclusion, the Jerusalem Post claimed that the undoubted ‘highlight of the seminar’ was Titmuss’s participation. His opening address and comments during discussion had provided participants with ‘a valuable frame of reference in which to assess the magnitude of Israel’s problems’ in respect of its social services.73 Titmuss’s lecture, entitled ‘Major Goals in Today’s Welfare State’, embraced a number of key issues in his philosophy, and was reproduced, with minor revisions, in an edited volume in 1966.74 Titmuss told his audience, first, that there should be no ‘authoritarian role’ for experts in social welfare, with those working in the field better described as ‘social servants’. In modern democratic states, choices about welfare had to be continually made, and to rely on yesterday’s

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solutions ‘is eventually to leave society without a sense of social direction’. On the other hand, nor could this ‘social direction’ be found ‘by forgetting about the past in a single-​minded search for more material wealth’. Economic growth, and social growth, were interdependent. The latter could not only make a ‘positive contribution to productivity’, but also reinforce ‘the social ethic of human equality’. One problem of Britain’s ‘welfare state’ was that, when created, it inherited many staff from existing services and, although this was not explicitly spelled out, their associated attitudes. A ‘more humane and informed administration’ was needed, especially to make contact with society’s ‘unreachables’; ‘the “Welfare State” has no meaning unless it is positively and constructively concerned with redistributive justice and social participation’. Such ambitions, though, ‘may collide in the short term with the need to increase economic productivity and to raise the standard of living’. Titmuss, in a striking passage, then suggested that while ‘we cannot be sure that this collision is inevitable’, it was tempting to argue that ‘when we are richer we can afford to be more generous to the less fortunate’. By the same token, though, ‘can we be sure that in the processes of getting richer and of concentrating only on getting richer we shall not, as a society, lose the impetus to create a more equal and socially just community?’75 There were various outcomes of Titmuss’s visit. In December 1964 he told Kanev that, during a recent trip to New York, he had met with United Nations staff. ‘The Israeli seminar’ had ‘created a great deal of interest and thought is now being given to using [it] as a model for other countries’.76 One of those involved was the chief of the UN’s Social Services Section, Martha Branscombe. In the run-​up to their meeting, Branscombe had suggested that the focus of their discussion be the ‘crucial problem involved in the development of training programmes for social work and social administration, particularly in developing countries’.77 When Titmuss and Branscombe met, he was able to inform their discussion with his Jerusalem experience. Two months earlier,Titmuss received a letter from Kenneth Lindsay, Director of the Anglo-​Israel Association, to which Titmuss belonged. Lindsay had ‘carefully read’ his Jerusalem speech, and invited Titmuss to address the Association. His talk should be ‘possibly angled towards Israel rather more than in the original’, beside which comment Titmuss wrote ‘Yes’.78 A meeting,‘The Welfare State: Objectives in Israel: Reflections on Britain’, duly took place at the LSE in February 1965, organised by the Association.79 Titmuss disclaimed expert knowledge of the Israeli situation. His observations were those of a ‘reasonably intelligent observer’ who had nonetheless ‘developed, in recent years and

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from a growing number of friendships in Israel, a fascinated interest in the challenge of social integration and the role that social policy may contribute to the welfare of the new, the old –​indeed, to the common cause of statehood’. He then gave an account of the Jerusalem seminar which was, notwithstanding his attendance at many similar events, ‘in a number of ways quite unique’, especially in bringing together senior officials from a number of departments for nearly a week.80 Various themes had been identified, and Titmuss’s role was to ‘guide, interpret and comment on the discussions on the various papers’ contributed by a range of individuals from a range of agencies. Katz, ‘whose diplomacy and skill helped to make the Seminar a success’, had ‘greatly assisted’ Titmuss in his task. But why was it necessary to hold such a meeting, given the ‘remarkable achievements in social welfare’ following the ‘ingathering of the exiles from many lands and many cultures’? The answer lay, partly, in unforeseen problems in absorbing new immigrants. Commenting on what was becoming a received view of Israeli society’s trajectory, Titmuss suggested that the ‘old idealism of the early pioneers’ had drawn much inspiration from the ‘the value of labour’. This had not only waned, ‘but the solution –​the ideology of work –​was not of itself a sufficient response to the rising expectations of many of the immigrants –​especially among the young and the second generation’. Another problem lay with the ‘growth of materialistic self-​seeking’ and increasing inequality. Although Israel, when compared with the UK, ‘may still be described as an egalitarian society’, nonetheless disparities in wealth, income, and educational opportunity had recently emerged. As in other societies, a tendency had developed to ‘thoughtlessly condemn the poor for their poverty’. It was easy, moreover, to portray welfare as an ‘unnecessary luxury’, when so much defence spending was required. Finally, Israel, for ‘no doubt well-​understood historical reasons’, had developed ‘quite a genius for creating complexity –​especially in the field of health and welfare’. This had implications for, among other things, the cost of services.81 The Association subsequently published the talk. In his foreword, Lindsay, who had chaired the meeting, highlighted some of Titmuss’s ‘many books’. Those who had read them would ‘know something of his quality and penetrating mind’. The pamphlet  also recorded the ensuing discussion, with Titmuss elaborating on various points. For instance, one of the ‘current problems in Israel’ was the ‘very large area of discretion’ left ‘to local officials and others administering assistance and welfare programmes’. Such discretion ‘in dealing with the poor, the new immigrants, allows moral judgements to operate’. This had been a major talking point at the seminar, and Titmuss had found

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it ‘encouraging’ the extent to which ‘more and more people were recognising this’. The challenge, therefore, was to provide immigrants with appropriate aid without discriminating against them. And on the subject of assimilating new immigrants, and their exposure to Western individualistic values, Israel had not, as yet, ‘fully understood what may be some of the psychological consequences’ of the ‘rapidly forced acceptance of different cultural values’. One way of addressing this was through ‘better-​trained social workers’.82 Titmuss’s contribution to the Jerusalem seminar, and its aftermath, again raised matters of central importance to his approach to social policy. These included the question of ‘discretion’ in the allocation of benefits, the social impact of immigration, the need for properly trained social workers, and the idea that economic growth was not, of itself, an adequate driver of social progress, and might lead to widening inequalities. In the wake of the Anglo-​Israel meeting,Titmuss received a letter from Katz. The latter had been pleased to hear that the event had gone well, and told Titmuss that the ‘Seminar, and, especially, your Seminar paper is being referred to very often here’. Shortly afterwards, Katz asked Titmuss for copies of the Association pamphlet. He also invited Ann and Robin Oakley to visit Jerusalem, and they accepted.83 On his return to Israel in 1967, Titmuss delivered a speech at the opening of a new building at the Paul Baerwald School. Among the other participants were a number of acknowledged authorities on social work, including Eileen Younghusband. Katz’s introduction to the published conference proceedings cited, approvingly, Titmuss’s arguments that the pursuit of knowledge in universities was neither a morally neutral process, nor one divorced from the rest of society, and that the ‘economic market’, rather than the ‘social’ or ‘humanitarian market’, had recently dominated the development of universities.84 Titmuss’s talk,‘The University and Welfare Objectives’, was delivered at the time of ‘The Troubles’ at the LSE. As we shall see in Chapter 28, he alluded to these disruptions in Jerusalem. Here we pick out some of his more general points. Titmuss denied that he was an expert on ‘the university’, the sociology of education, or ‘theories of administrative behaviour which may or may not account for the government of or misgovernment of universities’. His own approach derived from his ‘strong belief ’ that one purpose of modern universities was ‘to help society make more informed political choices about economic growth, about social growth and about educational growth’. Titmuss then outlined his own experience of academic life.This included not only his School responsibilities, but also that of ‘examiner and adviser’ to around 20 other universities in Britain, North America, and Africa,

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all in addition to teaching, writing, and administrative duties. For many years he had also been, in Katz’s expression, a ‘faculty errand boy’. Next came the ‘schizophrenias’ of higher education, the most ‘traumatic’ of which had come with a LSE document entitled ‘The Burden of Teaching’. To Titmuss, a committed teacher, such phrasing would have been anathema. There had never been a ‘greater need for teaching’, especially ‘those forms of teaching which educate for change, and which educate young people for careers in a variety of technical, administrative and service responsibilities’. This had arisen because societies faced ‘an information explosion, a population explosion and a financial explosion’. Moreover,‘welfare objectives’ reflecting society’s need for ‘increased social mobility and for social and ethnic integration’ were bringing to universities students needing higher levels of instruction than could be provided by staff hired purely on their research records. Adding to the pressure, serious questions were now being asked about the efficiency, and value for money, which universities provided.85 Titmuss’s proposals for a revitalised university sector thus included training more social workers, nurses, and town planners. Universities had, furthermore, to abandon their role in promoting ‘social conservatism’. It was untrue that universities historically had enabled social mobility –​rather, they had buttressed social inequalities. Nor was social class the only issue. Class divisions were, in both Britain and Israel, ‘inextricably bound up with the problem of ethnic divisions’. In the coming decade some half a million children of various immigrant groups would seek educational opportunities in Britain. Were they to experience the same difficulties in gaining these as working class children presently did, ‘then it will not be surprising if their failure to do so is attributed to racial prejudice’. Necessary changes therefore included specialised vocational courses for children from poorer homes, and quotas ‘designed to widen higher educational opportunities’.There was, too, a distinction between individual academic freedom, which was indisputable although staff should not be above criticism, and that of institutions. Universities should not be free to ‘ignore completely the needs of society’. So far, they had been slow to respond to these challenges, but without change were ‘in danger of failing in their obligations to society’. Such attitudes were not irreversible, however, and Titmuss concluded that he criticised universities ‘because I believe in them and the values they stand for; there are indeed times when it is right to admonish those whom one loves’.86 There was an interesting coda to this talk, which opened the panel on ‘The University and Social Welfare’.Titmuss summed up the session,

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reflecting that one of the ‘greatest problems’ facing the world was the ‘widening gap’ between rich and poor countries. Turning to Israel, the issue of poverty was presenting ‘important challenges, not just to the conscience of Israel, but to the university’. When the records of universities in North America, Britain, and Europe were examined, it was evident they had contributed little to understanding poverty, with most of the relevant work coming from those outside higher education. Therefore, it was ‘most encouraging that the School of Social Work here [in Israel] is beginning to grow, beginning to develop a number of people who see the connection between the education of social workers and the understanding of the social conditions of the poor’. On his third visit to the country, Titmuss concluded, it was ‘good to see this progress’.87 Titmuss was not, though, uncritical of Israel. In May 1968 Katz thanked him for ‘sharing with me the copy of your letter to our Ambassador in London’. Both he and his wife were sorry that Titmuss had had to write it, but glad ‘that you wrote as a friend of Israel’.88 It is unclear what Titmuss had written about, but earlier that month Israel had celebrated its fortieth anniversary with a military parade in Jerusalem, an event condemned at the United Nations. Titmuss’s friendly, but critical, approach may explain an enigmatic exchange of letters in late 1969. He was invited by Abraham J. Marks, of the Board of Deputies of British Jews, to join a proposed British Committee for Jews in Arab Countries.This was to consist of ‘distinguished non-​Jews’, and to be concerned with the persecution of Jews in countries such as Egypt.89 Titmuss replied that he had recently returned from Israel where he had had ‘the honour of being received by the Prime Minister’, and he had thus considered his invitation letter ‘in the light of this visit’. He concluded that as a result of ‘my commitments in Israel and other special circumstances, which I do not think it is necessary to describe in detail’, it would be best if he declined the invitation. Titmuss felt sure Marks would understand.90 Titmuss’s final visit, in 1969, is notable for his attention to the about to be published The Gift Relationship, discussed in Chapter 27. A few months before his death, he contributed a preface to the Hebrew edition of this work. Here Titmuss affirmed his belief that ‘the concept of “social man” will grow in Israel … based on what I have learnt from four visits to that country and on the many enduring friendships that I have made’. He especially acknowledged his longstanding relationship with Katz and his wife. Titmuss also told Katz that the ‘bone cancer and other unpleasant things have their ups and downs but at least it gives one the hope of welcoming spring with open arms and

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the thought that the four of us may be able to have holiday somewhere in the Mediterranean later on in the year’.91 Sadly, this was not to be.

Conclusion In engaging with the less developed societies discussed in this chapter, Titmuss, as always throwing himself whole-​heartedly into projects he was not obliged to undertake, demonstrated his commitment to advancing equality internationally. This was all the more commendable in the light of his always fragile health. In the case of Israel, the policies and practices promoted were similar to those he advocated for Britain. Mauritius and Tanganyika, though, saw a rather different approach. In both cases, population policies and local geography were to the fore. Consequently, it had to be recognised that what was appropriate for Western societies did not necessarily apply elsewhere. This in part, although only in part, explains the proposal for, most notably, a means test in Mauritius. Problematic as this is, it does, more positively, suggest a recognition on Titmuss’s part of the need to adapt to specific, local, conditions. Notes 1 LSE/​Staff Files/​Titmuss, letter, 18 October 1963, RMT to Caine. 2 G. Steinmetz,‘A Child of the Empire: British Sociology and Colonialism, 1940s-​ 1960s’, Journal of the History of the Behavioral Sciences, 49, 4, 2013, pp 353–78. 3 Sheard, The Passionate Economist, pp 157–​8. 4 In 1964 the independent nation of Tanganyika merged with Zanzibar, a former British protectorate, to form Tanzania. Here the names are used as they were at the relevant times. 5 For Abel-​Smith and, especially, Mauritius, see ibid, pp 157–​81. On these points I am grateful for the email correspondence, May 2019, with Professor Sheard. 6 R.M.Titmuss and B. Abel-​Smith, assisted by T. Lynes, Social Policies and Population Growth in Mauritius, London, Methuen and Co, 1961, pp xi, citing letter to Titmuss, January 1959, pp xi, xiii, xiv. 7 LSE/​Staff Files/​Titmuss, letters, 23 November 1959, RMT to Caine, and 26 November 1959, Caine to RMT. 8 J.E. Meade, G. Foggon, H. Houghton, N. Lees, R.S. Marshall, G.M. Roddan, and P. Selwyn, The Economic and Social Structure of Mauritius, London, Methuen and Co, 1961. 9 J.E. Meade, ‘Mauritius: A Case Study in Malthusian Economics’, The Economic Journal, 71, 1961, pp 521–​34. 10 Titmuss et al, Social Policies, pp 240–​41, 233, 3. 11 Ibid, pp 242, 246–​7, 248. 12 TITMUSS/​8/​9, letter, 8 November 1972,Young to RMT. 13 ‘Memorial Service: Professor R.M.Titmuss’, The Times, 7 June 1973, p 21; Oakley, Father and Daughter, p 33.

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Mauritius, Tanganyika (Tanzania), and Israel 14 J. Midgley, ‘Imperialism, Colonialism and Social Welfare’, in J.  Midgley and D.  Piachaud (eds), Colonialism and Welfare:  Social Policy and the British Imperial Legacy, Cheltenham, Edward Elgar, 2011, p 38. 15 TITMUSS/​3/​370, undated (but probably 1961) typescript, ‘Medical Ethics and Social Change (with special reference to Mauritius)’, pp 4–​5 (emphasis in original). 16 R.M. Titmuss, B. Abel-​Smith, G. Macdonald, A. Williams, and C. Wood, The Health Services of Tanganyika: A Report to the Government, London, Pitman Medical, 1964, pp vii–​viii. 17 TITMUSS/​5/​641, letter, 12 July 1962, RMT to M.M. Kamaliza, Minister of Health and Labour, Tanganyika. 18 Titmuss et al, The Health Services, pp viii, ix, x, xi, xii. 19 TITMUSS/​5/​641, letter, 4th March 1963, Maswanya to Lord Twining. Twining then passed this letter to Titmuss. Twining had been the last Governor of Tanganyika, and had also worked in colonial administration in Mauritius. 20 TITMUSS/​5/​641, letter, 1 November 1963, RMT to Arthur Williams and 13 December 1963,Williams to RMT;‘The Health Services of Tanganyika: A Report to the Government’, Medical Care, 2, 1, 1964, pp 27–​9. 21 TITMUSS/​7/​71, ‘Note of a Talk with Mr P. Sutcliffe of the Dartington Hall Trustees, 11th December 1963’. 22 C. Pratt, ‘Julius Kambarage Nyerere’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 23 C. Pratt, Julius Nyerere and the Ethical Foundations of His Legacy’, The Round Table, 89, 355, 2010, pp 366–​7. 24 TITMUSS/​6/​702, letter, 16 August 1962, RMT to Rein. 25 TITMUSS/​5/​641, letter, 18 September 1962, RMT to Twining. 26 Titmuss et al, The Health Services, pp 75–​6, 78, 79, 222, 224, 226–​31, 234–​5. 27 Ibid, pp 232–​4. 28 D. Piachaud, ‘Fabianism, Social Policy and Colonialism: the Case of Tanzania’, in Midgley and Piachaud (eds), Colonialism and Welfare, pp 134, 136. 29 Collated from TITMUSS/​6/​692, letters, 20 February 1968, RMT to Bill Hughes, Ruskin College, Oxford, and 19 June 1968, RMT to Mark Wheeler, Institute for Development Studies, University College, Nairobi. 30 TITMUSS/​6/​692, letter, 1 January 1968, RMT to Nyerere. 31 TITMUSS/​6/​692, letter, 19th June 1968, RMT to Wheeler. 32 TITMUSS/6​ /6​ 92, copy of International Planned Parenthood News, 170,April 1968, article ‘Tanzania Holds Successful Seminar’, Titmuss quoted p 2. 33 TITMUSS/​6/​692, Receipt from Mikumi Wildlife Camp, for three persons in two tents, 8 February 1968. It is not known who the third person was. 34 LSE, LSE/​Central Filing Registry/​514/​1/​K, letter, 31 January 1963, RMT to Caine. 35 TITMUSS/​4/​580, letter, 12 March 1965, N.  Leach, Ministry of Overseas Development, to RMT, with attached ‘Confidential’ document, eight pages, pp 1, 8. 36 TITMUSS/​4/​580, letters, 6 August 1970, W.A.C. Mathieson to RMT, and 13 August 1970, RMT to Mathieson. 37 COHEN, box 235, folder 7, letter, 25 June 1973, Kay to Eloise and Wilbur Cohen. 38 Oakley, Father and Daughter, p 33. 39 LSE/​Staff Files/​Titmuss, letter, 13 March 1963, RMT to Caine. 40 A. Doron,‘The Labour Movement and Welfare Policy in Israel, 1948–​1977’, Israel Affairs, 24, 1, 2018, pp 28–​9.

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RICHARD TITMUSS 41 TITMUSS/​5/​665, letter, 14 April 1959, Kanev, Social Research Institute, Tel Aviv, to RMT. 42 TITMUSS/​5/​665, memo, 9 July 1959, RMT to Caine. 43 TITMUSS/​5/​565, letter, 23 October 1959, Caine to Kanev; and typescript, ‘Possible Programme for Dr Kanev’, November 1959. 44 I. Kanev, Israel’s War on Poverty, American Histadrut Cultural Exchange Institute, New York, 1971, pp iv, viii. 45 Sheard, The Passionate Economist, pp 29, 151–​4, 182. I am grateful to Professor Sheard for reminding me of this point. 46 D. Macarov, Social Welfare: Israel Today, no 15, Jerusalem, Israel Digest, 1963, p 31. 47 Doron, ‘The Labour Movement’, pp 35, 40. 48 TITMUSS/​5/​660, letter, 29 September 1962, Kanev, Health Insurance Institute, to RMT. 49 Macarov, Social Welfare, p 30. 50 Oakley, Father and Daughter, p 76. 51 See the various correspondence in TITMUSS/​5/​660 and, in that file, letter, 3 July 1963, RMT to Katz regarding the latter’s visit to London. 52 TITMUSS/​5/​662, letter, 24 July 1968, RMT to Katz informing him of his assumed Senior Common Room membership. Other correspondence in this file suggests this was an understandable, but naïve, assumption on Titmuss’s part. 53 R.M.Titmuss,‘Concluding Remarks’, in I. Katz and H. Silver (eds), The University and Social Welfare. Jerusalem, The Hebrew University, 1969, p 57. 54 TITMUSS/​5/​666b, letter, 12 February 1963, Kanev to Kay Titmuss. 55 TITMUSS/​5/​660, letter, 8 February 1963, Kahn to Huws Jones, who passed the letter on to Titmuss. 56 TITMUSS/​5/​660, letter, 8 March 1963, Kahn to RMT. 57 TITMUSS/​5/​666, ‘Itinerary for the Visit of Prof and Mrs Titmuss’Visit in Israel, March 23rd to April 7th, 1963’. 58 TITMUSS/​5/​660, cutting from the Jerusalem Post, 22nd March 1963, I. Kanev, ‘Visitors’ Gallery: Prof Richard Titmuss: The Cure for Poverty’. 59 TITMUSS/​5/​660, cutting from the Jerusalem Post, 2nd April 1963, Dr A. Marcuss, ‘Prof Titmuss Attacks Market System on Medical Services:  The Doctors’ Dilemma’. 60 TITMUSS/​5/​666b, Typescript, 17 pages, RMT, ‘Social Welfare in the Modern State’, March 1963, pp 1–​2. 61 B. Reich, ‘Israel’s Policy in Africa’, Middle East Journal, 18, 1, 1964, p 16. 62 TITMUSS/​7/​71, letter, 19 April 1963, RMT to Michael Davis. 63 TITMUSS/​5/​660, letter, 23 April 1963, Kanev to RMT. 64 TITMUSS/​5/​660, letter, 24 April 1963, Kanev to RMT. 65 TITMUSS/​5/​660, letter, 26 June 1963, Kanev to RMT. 66 TITMUSS/​5/​660, letter, 12 June 1963, Shlomo Amir, Economic Assistant to the Minister of Finance, to RMT. 67 TITMUSS/​5/​660, letter, 20th October 1963, Shlomo Amir, Economic Assistant to the Prime Minister, and Moshe Sandberg, Economic Adviser to the Minister of Finance, to RMT. 68 TITMUSS/​5/​666, letter, 7 August 1964, Jean Iliovici, Chief, European Social Welfare Programme and Social Services Section, Office of Social Affairs, European Office of the United Nations, to RMT. 69 TITMUSS/​5/​660,‘Itinerary of Prof Richard M. Titmuss’, undated but regarding 1964 trip.

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Mauritius, Tanganyika (Tanzania), and Israel 70 TITMUSS/​5/​660, letter, 28 August 1964, Dr G. Lotan, Director General, National Insurance Institute, to RMT. 71 TITMUSS/​5/​660, letter, 5 October 1964, RMT to Aran. 72 TITMUSS/​5/​666, programme, Seminar on Objectives for Social Services in Israel, Jerusalem, The Hebrew University Campus, 31 August to 3 September 1964. 73 TITMUSS/​5/​666, cutting, 4 September 1964, Jerusalem Post. 74 TITMUSS/​3/​370, typescript,August 1964,‘Major Goals in Today’s Welfare State’; R.M.Titmuss, ‘Goals of Today’s Welfare State’, in P. Anderson and R. Blackburn (eds), Towards Socialism, Ithaca, NY, Cornell University Press, 1966. 75 TITMUSS/​3/​370, typescript, August 1964, ‘Major Goals’, pp 1, 6, 7, 13–​14, 17. 76 TITMUSS/​5/​660, letter, 14 December 1964, RMT to Kanev. 77 TITMUSS/​7/​72, letter, 22 October 1964, Branscombe to RMT. 78 TITMUSS/​5/​666, letter, 7 October 1964, Lindsay to RMT. 79 TITMUSS/ ​ 5 / ​ 6 66, ticket, ‘Anglo- ​ I srael Association:  Professor Richard Titmuss Will Speak on the Welfare State: Objectives in Israel: Reflections on Britain: Followed by Panel Discussion’, LSE, 10 February 1965. 80 TITMUSS/​5/​666, four-​page typescript, RMT,‘The Welfare State: Objectives in Israel: Reflections on Britain’, pp 1, 2–​3.This document is dated, in handwritten note,August 1964, but this is almost certainly wrong. It was more likely composed sometime after Lindsay’s invitation. 81 Ibid, pp 3–​4. 82 R.Titmuss, The Welfare State: Objectives in Israel: Reflections on Britain: Pamphlet no 7, London, The Anglo-​Israel Association, 1965, pp 3, 17, 20. 83 TITMUSS/​5/​666, letter, 30 April 1965, Katz to RMT, and TITMUSS/​5/​664, letter, 1 June 1965, Katz to RMT. 84 I. Katz, ‘Introduction’, in Katz and Silver (eds), The University, pp 2, 5–​6. 85 R.M. Titmuss, ‘The University and Welfare Objectives’, in Katz and Silver (eds), The University, pp 36–​45. Reprinted in Commitment to Welfare. References here are to the Commitment to Welfare version, pp 25–6, 26–​7, 27–​8, 28. 86 Ibid, pp 31, 33, 34, 35. 87 Titmuss,‘Concluding Remarks’, in Katz and Silver (eds), The University, pp  56–​7. 88 TITMUSS/​5/​662, letter, 10 May 1968, Katz to RMT. 89 TITMUSS/​5/​662, letter, 11 December 1969, Marks to RMT. 90 TITMUSS/​5/​662, letter, 18 December 1969, RMT to Marks. 91 TITMUSS/​AO, letter, 3 January 1973, Katz to RMT, accepting latter’s preface; and letter, 15 January 1973, RMT to Katz.

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19 Scottish social work and the Seebohm Committee Introduction The expression ‘welfare state’, which Titmuss disliked, is problematic, not least in implying planned, integrated services. But this has never been the case. To take the example of the NHS, in Titmuss’s lifetime this had a tripartite structure whose three components were the hospital service, primary care, and local authority services. All this was troublesome from the outset because of, for instance, the different geographical boundaries used by each part. To focus on local authorities, these had retained responsibility for public health, under the supervision of a Medical Officer of Health (MOH). Among local authorities’ other responsibilities were the personal social services, education (including the school meals and medical services), and housing. They varied, moreover, in their political composition, and potentially in policy implementation.Add to this that Scotland,Wales, and Northern Ireland had, to varying degrees, their own organisational structures and welfare cultures, and it will be evident that the ‘welfare state’ was far from a centralised, monolithic institution. Against this confusing background, this chapter examines Titmuss’s involvement with changes in Scottish social work and, contemporaneously, with the Seebohm Committee, set up in late 1965 to review local authority social work services in England and Wales.Titmuss viewed both these developments as broadly positive, and as having wider implications. As he told the first meeting of the Social Administration Association in 1967, in a speech seeking to clarify further his field’s scope, the ‘problems of how to teach social administration in non-​specialist as well as specialist ways will receive added force’ when, alongside other policy developments, Seebohm

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reported, and the impending changes in Scottish social work took effect.1

Scottish social work Titmuss contributed to the Scottish White Paper on Social Work, precursor to the 1968 Social Work (Scotland) Act. This put social work in Scotland on a different path from elsewhere in Great Britain, notably through the creation of Children’s Panels. These effectively took offending young people out of the adult justice system, and more directly into social care. The Act also integrated all existing welfare functions for children and young people. The need for an investigation into Scottish social work had been prompted by the findings of the Kilbrandon Committee, published in 1964, which had investigated juvenile delinquency. This came shortly after the Ingleby Committee had investigated the same issue in England and Wales. Juvenile delinquency was a controversial matter in the 1950s and 1960s, and the two committees reflected widespread popular concern. Titmuss’s role in the Act’s origins, and his positive view of it, was acknowledged by an invitation to a lunch celebrating its coming into force in late 1969. He had to decline, but sent his greetings, and the message that ‘I and others expect to learn a lot of lessons from Scotland’s lead!’2 In summer 1965, Labour’s Secretary of State for Scotland, William Ross, told Titmuss that the Scottish Office had decided to implement the Kilbrandon Committee’s recommendations, and that this would require ‘a fairly radical reorganisation of the social work services’. Ross invited him to be a consultant to, in particular, the Scottish Home and Health Department (SHHD), and the Scottish Education Department. The Scottish Office was ‘keenly interested in trying to make the best use of the opportunity provided by the Kilbrandon Report to improve the efficiency of local authority social work; and we are anxious in having the best possible advice in doing so’. Titmuss accepted, noting that he had already attended a meeting with the minister responsible for leading on the White Paper, the MP for Lanark, Judith Hart.3 Titmuss and Hart went back a long way. In a 1967 television interview on her appointment as Minister of Social Security, Hart gave a brief account of herself. She had taken a sociology degree at the LSE, and then had gone ‘straight into social research, where I worked under Professor Titmus [sic]’. The last was, presumably, a reference to Hart’s work, immediately post-​war, for the Ministry of Health at the point at which Titmuss was working on Problems of Social Policy.4

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Back in 1965, Hart told Titmuss that Parliament would be informed within days about what she called ‘Kilbrandon Part II’ (those contributing to the White Paper were collectively referred to as the Kilbrandon Study Group), including ‘your kind agreement to become our consultant’. The names of two ‘honorary advisors’, Kay Carmichael and Megan Browne, would also be announced, although their participation would come later. Illustrating the parochialism of 1960s Scottish society, Hart noted that this part of the announcement was ‘purely tactical’, since the reaction if they are not mentioned, will be ‘haven’t we anyone in Scotland good enough to advise the Secretary of State?’ One can always be sure that someone will say this! Indicating that two people from the Scottish Universities are also involved will prevent this happening.5

The universities in question were, in the case of Browne, Edinburgh, and in the case of Carmichael, Glasgow. Carmichael was to marry David Donnison, at this point an LSE colleague of Titmuss’s. Donnison later argued that Titmuss, Browne, and Carmichael’s engagement with Scottish social work was ‘one of the most successful contributions to innovation in social policy’. Their approach had been ‘opposed in Whitehall at the time but [was] now widely applauded’.6 In October 1966, a few days before the White Paper’s publication, the SHHD civil servant responsible, J.O. Johnston, wrote to Titmuss. Johnston noted that Titmuss’s ‘interest as an adviser in this connection is, of course, publicly known and is mentioned in the White Paper’, and that consequently he might be approached by the media.Titmuss agreed that, in such an event,‘I shall be glad to do what I can to further the presentation of these proposals’.7 But what were they? One way of addressing this question, and the part Titmuss played, is by way of the reaction the White Paper provoked. In an article entitled ‘Scotland First’, The Economist noted Kilbrandon’s significance, its proposal to merge all children’s services into one department, and that opinion in England ‘has gently moved along Kilbrandon lines’. But now the Scots wanted to go further,‘by proposing the consolidation of all social welfare work for people of all ages into a single department of city and county administrations’.That the White Paper’s recommendations were of ‘more than parochial interest’ was witnessed by ‘the presence of the Sassenach Professor Titmuss among the experts who advised the authors’.8

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If The Economist, generally hostile to Titmuss’s views, was fairly neutral in its response, the medical profession was openly sceptical. The Medical Officer, the journal associated with the MOsH, sensed that the ‘Titmuss line seems to have won the day in Scotland, at least in the skirmishing stage of the reorganization of community health services’. Noting the involvement of Titmuss, Carmichael, and Browne, it claimed that ‘the persuasive arguments of the social scientists were met halfway by the receptiveness shown by the present Government for the proposals of eminent theoretical academicians’. But how far could such schemes ‘get divorced from the realities of practical experience?’ The White Paper also had to be seen as representing official thinking at the UK as well as the Scottish level ‘at the very time the same questions are under active deliberation by the Seebohm Committee’. Equally worrying, the ‘socio-​medical considerations’ put forward by the Society of Medical Officers of Health had been largely ignored.9 The BMJ likewise discussed the Scottish document in the context of Seebohm, concluding, in a passage highlighted by Titmuss on his own copy, that the medical profession as a whole ‘should study these proposals with the greatest care’. The ‘transfer of medical and social functions’, presently performed by doctors, to ‘lay staff could have gravely adverse effects on the well-​being of the community’. In addition, shifting the administration of ‘medical and quasi-​medical functions to the overlordship of a non-​medical person may well be thought repugnant to the principle of the freedom and independence of the medical profession and a threat to ethical standards’.10 The professional body representing MOsH in the West of Scotland, meanwhile, unanimously rejected the White Paper. It claimed, in a public statement, that it consisted of ‘the views of academic theorists … so far up in the clouds that they had little if any experience of actually organizing local authority social services’. Should all its proposals be carried out, then ‘the result would sound the death knell for medical officers of health’.11 Taken together, these comments are revealing of the medical profession’s hostility to ‘theoretical’ rather than ‘practical’ interventions, particularly when the former are put forward by social scientists such as Titmuss. The ‘death knell’ comment was, as it turned out, prescient. However,Titmuss also had his supporters. Reg Wright, of the Council for Training in Social Work, congratulated him ‘on the important part you played in the production of the Scottish White Paper which seems to me very good’. He was, though, mildly disappointed about its proposals for social work training.12 Titmuss agreed that the relevant section was ‘thin’, but this was partly deliberate. It was all ‘mixed up with the problem of “academic freedom” and pressures which we hope

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to bring to bear’ on Scottish universities with respect to training.13 What did this mean? A few months after becoming involved with the Scottish White Paper, Titmuss received a letter from Michael Swann, Principal of the University of Edinburgh. Swann congratulated ‘one of our graduates’ –​Titmuss had received an honorary doctorate in law from Edinburgh in 1962 –​on his recent CBE. Swann also thanked Titmuss for agreeing to advise the university on its new Chair in Social Administration. Replying,Titmuss remarked that ‘it will be a pleasure to help in the task of an appointment to the Social Administration chair’.14 In a long letter in February 1966, Johnston noted that at the group’s most recent meeting, which had taken place a few days after the exchange between Swann and Titmuss, a discussion had taken place on how best to approach the Scottish universities. The question of the new chair at Edinburgh had arisen, and it was felt that the university would ‘find it helpful to have their attention drawn at an early date to the pattern of training which was likely to be needed for the future’. Johnston had, therefore, been asked to draw up a memorandum ‘which Professor Titmuss might use as he thought best in advising the University of Edinburgh about the new chair, and which at the same time could be the basis of the necessary consultation’ with various interested parties. Johnston reminded his colleagues of the sensitivities of universities around ‘academic independence’.15 This letter shows the link between the Edinburgh post, the deliberations of the Kilbrandon Study Group, and its strategy for social work training in Scottish universities. It also explains Titmuss’s comments to Reg Wright. The Chair in Social Administration at Edinburgh University was formally instituted in 1967. Its first incumbent was John Spencer, a criminologist who had taught in the Department of Social Administration at the LSE in the late 1940s and early 1950s, and who, until Titmuss’s arrival, was the only male lecturer on the social work courses.16 So the White Paper, the subsequent Act, and the new Edinburgh chair all attested to Titmuss’s influence.

The Seebohm Committee While all this was happening, the Committee on Local Authority and Allied Personal Services was set up, and started work. This body, sponsored by four government departments, was chaired by Frederic Seebohm, a banker with an interest in social reform whose many public commitments included being an LSE governor. The composition of the Committee was announced in December 1965, but the need for such an enquiry had been anticipated by a White Paper, published in

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August that year, The Child, the Family, and the Young Offender.17 Even before this, though, Robin Huws Jones of the National Institute for Social Work Training, soon to be a Seebohm Committee member, had brought together, in spring 1965, a group to agitate for the ‘integration of social work services’.This included Titmuss and Morris, as well as an old friend of Titmuss’s, the formidable Geraldine Aves. Aves had served in the Ministry of Health during the war, where her responsibilities had included the evacuation of London schoolchildren. Her work would thus have been known to Titmuss as he gathered information for Problems of Social Policy. After retiring from the Civil Service, Aves became involved with bodies such as the National Institute for Social Work Training, and she chaired the independent Committee of Enquiry on Voluntary Workers. It was in the latter capacity that she was to give evidence to Seebohm. She had also been tangentially involved with the social work dispute at the LSE. More generally, Aves, like Titmuss, was keen to improve social work training and increase the number of social workers. In 1965, she told a social work conference in Chicago that her talk’s title,‘Crisis in Manpower: The British Approach to Manning the Social Services’, was ‘somewhat dramatic’, and cited Titmuss’s ‘more modest phrase’ that there was a ‘growing demand for better educated and trained social workers and administrators to staff the social services’. But the two were singing from the same hymn sheet. Also in 1965, the Huws Jones group lobbied Douglas Houghton, responsible for social service coordination and review in the Labour government, for an enquiry into local authority social work services. Given what was to follow, the setting up of the Seebohm Committee must be, in part, credited to Huws Jones and his colleagues.18 Titmuss had, like Aves, made important and controversial interventions in the run-​up to the Seebohm Committee’s establishment. In spring 1964, he argued the need for ‘clearer and more precise definitions and allocations of responsibilities over the whole field of the local health and welfare services’. Among the questions this raised was whether MOsH were ‘equipped to administer, co-​ordinate and develop services to meet social needs’, or should such tasks ‘be the concern of a ‘social welfare service at local level?’19 A few months later, at a conference in Athens, he asserted that social workers must engage in ‘community diagnosis and education’. It was no longer ‘enough for social workers to talk to other social workers’, they must also seek ‘allies’ in the social sciences. Schools of Social Work should, therefore, embrace research and ‘devote some of their studies to problems of social policy’.20 One speech which made a particular impact came in April 1965, to the annual congress of the Royal Society of Health. In the first instance

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concerned with the need for more social workers, and enhanced social work training, this also dealt with the organisation of local social services, and particularly with those dealing with welfare, child care, and health. In a remark typical of his approach,Titmuss claimed that some professions, for example doctors and lawyers, were simply ‘associations for spreading the gospel of self-​importance’. The very volume of discussion about improving social service organisation, meanwhile, illustrated that ‘all is not well with the present arrangements of many local authorities’. But current arguments for family service departments, essentially an enlarged children’s department, were misguided. Rather, locally based departments of social service were required.These would embrace not only existing children’s departments, but also many of the functions currently carried out by other parts of local government, especially local authority health departments, currently the MOH’s domain. In a striking passage, Titmuss remarked that local government was ‘burdened with too many small departments and too much “balkanized” rivalry in the field of welfare’. Departments should be based on services, and not on ‘categories of client or particular fragments of need’. So if the over-​used term ‘community care’ was to have any meaning, it should be around the ‘provision of services which are essentially social, essentially personal and primarily local’.21 The talk was widely publicised.The Daily Mail, for example, suggested that any speech which argued that doctors put their own status before service to patients might expect to be poorly received at such a meeting. However, delegates instead ‘cheered the dark, gaunt professor who has been a backroom mind in Britain’s social services for many years’.22 On the same day, Titmuss appeared on radio. Introduced as someone ‘calling for a renaissance of GP service’, and who was believed to have ‘considerable influence in government circles’,Titmuss confirmed that he wanted greater emphasis on general practice, alongside closer local integration of hospital and GP services.What he had said in his speech ‘was not just a chance remark or bright idea’. On the contrary, it sought to ‘summarize the results of many years of patient study, research work, on problems of needs, of people in their own communities, in their own local areas; on the quality of medical care provided by general practitioners; and on how our social services are working’. The social services had ‘grown up, like so much has grown up in Britain, on a piecemeal basis’. They were ‘fragmented’ in a number of ways, with the result that ‘both the average citizen’ and GPs were confused about from whom they should seek assistance.23 The Hospital and Social Service Journal, meanwhile, noted Titmuss’s remarks on the use of social workers, observing that he was on ‘more

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controversial ground’ in suggesting ‘the creation of a department of social service within the local authority’. This was not unproblematic, and change for its own sake should be rejected. Nonetheless, his arguments could not ‘reasonably be dismissed without careful consideration’.24 Titmuss’s speech and its reception were important contributions to debates around the reform not only of the social services, but also, explicitly and implicitly, of health services, and their relationship to their communities. Abel-​Smith, in a thirtieth anniversary volume on the NHS, commented that, by the late 1960s, MOsH were worried about their future.25 Little wonder, given analyses such as Titmuss’s for both Scotland and England and Wales. The Huws Jones group met with Houghton in June 1965, with Titmuss, Aves, Huws Jones, and Morris among those present. The meeting was in response to the memorandum,‘The need for an enquiry into the integration of social work services at the local level’, the group had produced. Houghton explained that he had formulated ‘suggestions for modest changes in the local services available to families with children so that they would be better able to support and match up with the proposals which the Home Office had in mind’ (a reference to the latter’s plans for the treatment of young offenders). This was not, though, what the Huws Jones group sought.Titmuss ‘emphasised that as head of one of the largest departments responsible for training social workers, he was acutely aware of the increasing shortage of social workers and their inability to meet growing demands’. He was therefore convinced, in ‘pressing for a comprehensive enquiry’, of the need to ensure that the ‘best possible use was made of available manpower’. Like other group members, he believed that ‘the future structure of the social work services should not be prejudiced by premature action’.26 Shortly afterwards, Crossman recorded that Houghton’s position was one which he had taken up unenthusiastically. The need for a ‘really independent inquiry into the local authority services’ had been urged upon him earlier in the year by a ‘personal letter signed by Titmuss and practically every social scientist that I respect’. Consequently, and in alliance with the Education and Health departments, Crossman had defeated Houghton’s plans in Cabinet.27 So far, then,Titmuss and the Huws Jones group had got what they wanted, and here the direct appeal to Crossman seems to have played an important role. In September, shortly after the young offenders White Paper came out, Huws Jones wrote to Titmuss. He expressed his pleasure that they would be able to get together in the near future, not least because ‘Geraldine felt sure we should meet as soon as possible after your return, although I am not quite clear what we can do at the moment except

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cheer’. However, it would be possible to plan how to progress matters. Huws Jones also noted that Morris had phoned prior to his departure for America, ‘and I think he was hoping to drop a word in an influential ear about the contribution Geraldine could make’.28 Presumably what they had to cheer about was Houghton’s defeat and hence the postponement of a short-​term fix. And while it is not entirely clear from the letter, it seems that Morris, and by extension Titmuss and Huws Jones, were lobbying (unsuccessfully, as it turned out) for Aves to become a member of the Seebohm Committee. Such lobbying did, of course, go on. Sheard suggests, for instance, that Morris was recommended to the Committee by either Abel-​Smith or Titmuss.29 We see here a tight, well established, network of influential individuals, united in a common cause. Huws Jones, for example, had worked on the measurement of malnourishment in school children before 1939 and, like Titmuss, was a Fellow of the Royal Statistical Society. Even if the two did not know each other personally at that point, Titmuss used Huws Jones’s work in, to take one important example, Problems of Social Policy. In that volume Titmuss cited a 1937 speech made by Huws Jones which had demonstrated the unreliability of official statistics regarding children and nutritional intake. Titmuss’s relationship with Aves also highlights his ability to work with female colleagues, a point thrown into sharp relief by the fact that Aves was close to Eileen Younghusband.30 Another correspondent of Titmuss’s in autumn 1965 was Timothy Raison, founder and editor of the social science journal New Society, future Conservative MP, and member of the Huws Jones group. Presumably with Seebohm in mind, Raison argued that ‘in principle there is much to be said for having a couple of MPs on Committees of Enquiry’. He acknowledged that Titmuss might feel ‘that this conflicts with the idea of an entirely expert committee’. In the event that Titmuss agreed, however, Raison had two suggestions, drawn from Conservative MPs who were establishing their reputations as authorities on welfare –​Geoffrey Howe and Margaret Thatcher.31 Unfortunately, Titmuss’s reaction, if any, does not seem to have survived. But the fact that Raison thought that Titmuss could use his influence in such a way suggests just how powerful that influence was perceived to be, especially now Labour was in government. A few months later,Titmuss provided a summary of the direction in which he felt social work should go. Praising a new book by Anthony Forder, he described it as ‘important and much needed’. For Titmuss, social workers, like doctors, had ‘for too long been invested with the image of social entrepreneurs, playing a solo personality role with their

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clients and patients on an empty, unlit, private stage. Insofar as they are thought to do good they do it alone’. While this approach to social work might have been acceptable ‘during the pioneering days of charitable movements in the nineteenth century’, nowadays it was almost entirely misguided. Forder’s book was thus a ‘welcome addition to the literature which sees the social work process as an integral part of the administrative provision of services’. Up to this point, most writing on social casework, British and American, had been primarily concerned with how to understand clients and respond to their needs. This was undoubtedly important, but there had nonetheless been ‘a tendency to overlook many of the other dependent variables’. By contrast, Forder’s book ‘sees the social worker on a crowded and motley stage performing with a large and motley cast of not one but a variety of minor and major roles’. It was necessary, therefore, to locate social workers in terms of their relationships not only with their clients but with other administrators and service providers –​again, Titmuss’s aspiration for integrated, coordinated, services.32 We can see, too, a further hint of his scepticism about social work methods overly reliant on psychological explanations for client behaviour. Against this background, in March 1966 Seebohm told Titmuss that his Committee would ‘very much welcome the opportunity of an informal discussion with you on your ideas for reorganising local authority personal social services’. Committee members had ‘read with great interest’ the article based on his speech to the Royal Society of Health.33 The meeting duly took place on 15 April, and two days later Seebohm wrote again, in what he described as a ‘short personal note’, to thank Titmuss for his contribution. It was ‘just what I wanted to get the members down to some practical hard work’. He was now ‘dividing them into working groups with specific tasks so that we can have some framework to “extend and amend” as the evidence comes in’.34 So what did Titmuss tell the Committee?35 He started by denying any ‘Utilitarian passion for administrative tidiness’ while accepting the need for ‘radical change’. Such change should take account of eight principles.The first,‘Economies of Scale’, involved, among other things, local authority departments ‘large enough to make the most effective use of the few trained social workers who were available’. In social work, and in social service administration, the key issue was the quality of the staff which was, in turn, reflected in the quality of their work. Next, social services should be organised at a local rather than regional level. But here it was necessary to put local provision in a stronger position, and one way this could be done was to combine health, welfare, and children’s services. If such a merger took place, local authority social

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services would be better placed vis-​à-​vis services such as education and housing, ‘and their attraction to councillors and administrators increased’. Ultimately, local authorities might have a ‘social policy cabinet … membership of which would confer such prestige that it would be a normal and not a deviant thing for councillors to want to be on it’. Third, local authority departments should give, and receive, help from one another. So the ‘stronger the social work department, the more likely … that the education and housing departments would ask it do things for them’. Fourth, social work departments should be linked with services such as general practice, but not with crime agencies, a ‘mistake … being made in the United States’. Fifth, social workers and their administrators should be accountable. Sixth, a further advantage of merging the children’s, welfare, and health departments would be the more efficient use of information. This section was headed ‘Confidentiality’, implying that under the present system, where ‘responsibility’ might be ‘fragmented’, this was not always ensured. Under the last two headings Titmuss addressed concerns especially close to his heart,‘Social control of professional power’, and ‘Consumer Choice’. ‘Professional power’ was an issue in both small and large bodies. In the former, ‘the professional expert might become almost a dictator’. In the latter, however, there was more chance of the expert ‘being checked’ because of the presence of other professionals, and ‘the chief administrator would be better equipped to deal with him on an equal footing’. Larger departments would also be able to release staff more easily for training, so helping to enable the ‘departmental machinery’ to incorporate ‘some form of “self criticising” function’. As to consumer choice, the personal social services were ‘one of the growth points in society’.The public was, however, unlikely to continue tolerating ‘the take it or leave it attitude which was almost inevitable when an authority could provide no choice in, for example, the kind of accommodation available for old people’. For Titmuss, this was ‘another argument in favour of larger units’. Discussion followed, with Titmuss elaborating on various points, especially what he envisaged as appropriate new administrative structures. He confirmed, for instance, that his proposed new department would embrace not only existing children’s and welfare departments, but also parts of the health department, particularly mental health. Such a department should be headed by a chief administrator, supported by a chief social worker.Titmuss emphasised that the administrative staffing of such a body would ‘rely in the long term on attracting and training a new kind of social administrator’. Specially trained administrators should be allowed to compete with doctors and social workers for the

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post of chief administrator. On the question of ‘social control’,Titmuss ‘accepted completely that it was just as important to try to make workers accept their professional responsibilities as to provide means of controlling them’. In order to make professions self-​critically aware, their members had to work in groups, and these should be large enough ‘to provide scope for regular staff meetings’. A proper complaints procedure should also be established wherein one member of a profession could challenge another. As to the ‘Method of change’, Titmuss was ‘inclined to favour shock treatment rather than a gradual process’, the former providing ‘a better chance of getting the required resources’. Reflecting on the position by mid-​1966, Titmuss told a conference in Vancouver that in Britain, as in Canada and the United States, there was a serious shortage of social workers, partly caused by the expansion of existing services and the creation of new ones. Britain was moving towards ‘integrated community services, preventive in outlook and of high quality for all citizens’. There were now two possible ways forward. The first was a system based on local authority family service departments.The second was more ‘far-​reaching in terms of structural reorganization’. This rejected the notion of a ‘family service’, based on ‘biological or sociological criteria, such as the family, or on one element of needs’. Rather, provision should be arranged around ‘the need for services at the community level, irrespective of age, family background or behavior patterns’. Public concern over these issues had led to the creation of the Seebohm Committee, and the parallel enquiry in Scotland.Whatever the outcomes, the fundamental question was: were social services to ‘serve people’ or to ‘advance the interests of established organizations and professional groups’?36 As in his evidence to Seebohm, Titmuss was evidently convinced of the need for fundamental and radical change in local social service provision. Seebohm reported in 1968.37 Its outcomes were mixed. Pinker argues that it ‘gave social work a new mandate whose potential scope more than matched the optimism of the period’. In doing so, it rationalised social work training, and marked a shift away from social casework to a generic approach whereby social workers’ caseloads were not divided by specialism.This was the culmination of the debates encountered in Chapter 14. All this took place within a unified social services department, one of Titmuss’s aspirations, following the Local Authority Social Services Act, 1970. Nonetheless, Pinker also suggests, the Committee had never agreed on specific objectives, while the new social service departments were ‘burdened with universalist expectations’ for which resources were not forthcoming.38 So, from Titmuss’s viewpoint, it was only a partial success.

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A further outcome of Seebohm, following local authority reorganisation in 1974, was the demise of the MOH (a similar process took place in Scotland). In Chapter 17, we found Titmuss complaining, in 1967, of the ‘weaknesses in public health departments’ as revealed by, among others, Seebohm. A  few months earlier, Morris had spelled out to a Seebohm Committee meeting what he and Titmuss felt was wrong with such departments. Public health was now undoubtedly ‘the weakest branch of medicine’. Its influence had peaked at the end of the nineteenth century, and had been in decline since. It could not compete, in recruitment terms, with other medical specialisms. Consequently, morale was poor and the service was not doing what it was supposed to do, for example carrying out local epidemiological surveys. Removing further functions, such as the mental health service, would be ‘disastrous’ for staff confidence, and might lead to chaos and a total collapse of the whole public health service.This meant that social service reorganisation would be worthwhile only if ‘accompanied by the rebuilding of an effective community health service’. Questioned on this, Morris further elaborated. Such a service would be headed by a doctor ‘responsible for organising all the local health services and for advising other local services on health matters’.This official would also act as a local epidemiologist. Ideally, the existing separation between administration and research would end, while ‘administrators for the local health services, the hospitals and the Ministry [of Health] should be trained together’.39 While confusing on points of detail, the gist is clear. Public health, as traditionally understood, had had its day. At the very least, it had to be revamped to take account of modern developments in medicine, particularly the social medicine so avidly advocated by Morris and Titmuss. All this should be seen in the context of Titmuss’s contemporaneous contribution to the Royal Commission on Medical Education. So, in the face of this onslaught, the post of MOH finally expired, and Titmuss and Morris had played their part.

Social work and social workers Titmuss continued to press his vision of the best direction for social work’s development. Two years after Seebohm reported, he provided input to a book described by the authors as a ‘field experiment in social work’. Among those acknowledged was Titmuss who, ‘in spite of the heavy demands continually made on him, agreed to write a Foreword and in doing this made valuable comments about the manuscript’.The lead author was Tilda Goldberg, a refugee from Nazi Germany, who had started her long social work career by training as a psychiatric

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social worker at the LSE in the 1930s. Goldberg also had a long association, from 1949 to 1965, with the MRC’s Social Medicine Unit as a researcher working on, for example, the backgrounds of men with duodenal ulcers.40 She had thus been known to Titmuss for some considerable time. In his foreword,Titmuss noted recent criticism of certain professions for their alleged failure to assess their effectiveness in ‘the actual performance’ of their roles and functions.This debate was, partly, about the ‘exercise of power by these professions and the values underlying its use in situations of social control’. Specifically on social work, there were those who sought evidence ‘justifying the professional training of social workers’. Such criticisms were offered by, for instance, economists, who were ‘beginning to question whether more investment in education and the allocation of more resources for health care can be objectively justified on economic criteria’. But it was also being recognised that health and welfare professionals’ activities could not be ‘abstracted from the structure of resources and facilities’. Questions about social work’s effectiveness needed to be contextualised by ‘questions about the performance of the institutions and services within and around which the worker operates’. And while, in certain circumstances, the goals of health or welfare interventions might be clear, it was often the case that these were ‘ambiguous, conflicting or unclear’. In the particular case of social work, for the ‘great majority of people seen by social workers it is hard to determine mutually acceptable criteria of success or failure’. There could not, therefore, be ‘one unambiguous goal for social work’, just as there could not be ‘one unambiguous objective for the social services’. Indeed, it would be ‘terrifying if there were and if we thought there could be’. So what remained, and this was not something which could be embraced by the ‘material claims of the market’, was the notion that ‘increasing sensitiveness to the claims of others … is one important element in the definition of moral progress in society’.41 Titmuss’s commentary was therefore underpinned by the limitations of economic analysis, and the sense that the social services, and their outcomes, were complex and essentially unquantifiable. But for ‘moral progress’ to be made, service users had to be treated respectfully, and as individuals. As to the volume itself, it was ‘the first controlled field experiment in Britain in the complex and diffuse area of activities we call social work’. An important aspect of its findings was that one ‘critical element justifying social work and justifying training is the listening role’, for listening was ‘an essential part of social diagnosis as well as medical diagnosis’. It was also valuable in itself in social,

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cultural, and moral terms as demonstrating ‘respect for the dignity of others in a world which values speed, busyness, efficiency and activity’. Disciplined, effective listening led to ‘practical action attuned to client priorities, combined simultaneously with psychological help’. For those most in need, there was thus ‘relatively more action on their behalf; more resources were mobilized’. The trained workers were, therefore, functioning ‘selectively’.This analysis was ‘sharply at variance from the general run of utilization studies’, by which Titmuss presumably meant cost–​benefit analyses promoted by economists. However, the findings would not have been so positive ‘without the relatively generous infrastructure of services in the area studied’. Crucially, and by contrast, with ‘fewer universal resources and facilities available selectivity becomes less possible’. This opaque remark is, in fact, even more ambiguous than it seems for, as we shall see, Titmuss was by now grappling with how to balance universalism with selectivity. But he concluded on the positive note that ‘whatever qualifications may be attached to some of the findings what cannot be disputed is that methodologically this study is more advanced than similar social work experiments in the United States and other countries’.42 Oakley notes the originality of Goldberg’s study, and Titmuss’s support for its methodology and findings.43

Conclusion Titmuss argued for social work to be delivered from an administrative system which was integrated, inclusive, comprehensive, and localised. By the late 1960s, much of this had come about in Scotland, and in England and Wales, albeit to a greater extent in the former. Local government reorganisation was to further consolidate these changes, in which Titmuss had played a crucial role. One of the ‘casualties’ here was the post of Medical Officer of Health, created in the mid-​nineteenth century but now, for those such as Titmuss and Morris, obsolete and obstructive.As to social workers themselves, front-​line personnel of the ‘welfare state’, they should be, in Titmuss’s view, non-​judgemental and empathetic towards their client. As always, all this was to contribute to society’s ‘moral progress’. Notes 1 R.M. Titmuss, ‘The Subject of Social Administration’, in Commitment to Welfare, p 16 (emphasis in the original). 2 TITMUSS/​7/​77, letters, 6 November 1969, Beth Jones, Chief Advisor, Social Work Services Group, Edinburgh to RMT, and 11 November 1969, RMT to Jones.

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RICHARD TITMUSS 3 TITMUSS/​2/​211, letters, 28 July 1965, Ross to RMT, and 4 August 1965, RMT to Ross. 4 HART, Hart/​13/​71, Tellex Report (ie, transcription) for Ministry of Social Security, Information Division, of broadcast, 27 July 1967, on BBC South East ‘New Woman at the Ministry of Social Security’. 5 TITMUSS/​2/​211, letter, 2 August 1965, Hart to RMT (emphasis in original). 6 D. Donnison, ‘The Academic Contribution to Social Reform’, Social Policy and Administration, 34, 1, 2000, p 37. 7 TITMUSS/​2/​209, letters, 10 October 1966, Johnston to RMT, and 11 October 1966, RMT to Johnston. The report was published as Scottish Education Department and Scottish Home and Health Department, Social Work and the Community: Proposals for Reorganising Local Authority Services in Scotland, Cmnd. 3065, Edinburgh, HMSO, 1966. 8 TITMUSS/​2/​209, clipping, ‘Scotland First’, The Economist, 22 October 1966. 9 TITMUSS/​2/​209, clipping, ‘Social Work Blueprint for Scotland’, The Medical Officer, 28 October 1966. 10 TITMUSS/​2/​209, clipping,‘Medical and Social Welfare’, BMJ, 19 November 1966. 11 TITMUSS/​2/​209, clipping, The Times Educational Supplement Scotland, 16 December 1966. 12 TITMUSS/​2/​209, letter, 25 October 1966, Wright to RMT. 13 TITMUSS/​2/​209, letter, 27 October 1966, RMT to Wright. 14 TITMUSS/​2/​211, letter, 23 January 1966, Swann to RMT; and letter, 26 January 1966, RMT to Swann. 15 TITMUSS/​2/​211, letter, 8 February 1966, Johnston to Kilbrandon Study Group. 16 Edinburgh University Calendar, 1967–​1968, Edinburgh, James Thin, 1967, p xxvi; Dahrendorf, A History, pp 381–​2. 17 F. Boyd, ‘Scope of Family Service to be Reviewed’, The Guardian, 21 December 1965, p 3. 18 G.M. Aves, ‘Crisis in Manpower: The British Approach to Manning the Social Services’, Social Service Review, 39, 4, 1965, p 444; P.  Willmott, A Singular Woman: The Life of Geraldine Aves, 1898–​1986, London, Whiting and Birch, Ch 7, and pp 149–​51. 19 Titmuss, ‘Planning for Ageing and the Health and Welfare Services’, pp 100–​101 (emphasis in printed version).The speech was given to the National Conference on the Care of the Elderly, April 1964. 20 R.M. Titmuss, ‘The Relationship between Schools of Social Work, Social Research, and Social Policy’, International Social Work, 4, 1, 1965, p 9. Reprinted in Commitment to Welfare. 21 R.M. Titmuss, ‘Social Work and Social Service:  A Challenge for Local Government’, Journal of the Royal Society of Health, January 1966, pp 19–​21, 32. Reprinted in Commitment to Welfare. 22 TITMUSS/​2/​209, clipping, ‘Status before Service Doctors Rapped’, Daily Mail, 28 April 1965. 23 TITMUSS/​4/​558, typescript, BBC, ‘Extract from Ten O’Clock, Home Service, 28th April 1965’, p 1. 24 TITMUSS/​2/​209, cutting, Hospital and Social Service Journal, 14 May 1965. 25 B. Abel-​Smith, National Health Service: The First ThirtyYears, London, Department of Health and Social Security/​HMSO, 1978, p 38. 26 TNA, MH 156/​63. ‘Social Services at Local Level: Note on Meeting on 23rd June, 1965’.

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Scottish social work and the Seebohm Committee 27 R. Crossman, The Diaries of a Cabinet Minister:  Volume I, Minister of Housing 1964–​66, Hamish Hamilton/​Jonathan Cape, 1975, entry for 22 July 1965. 28 TITMUSS/​2/​209, letter, 1 September 1965, Huws Jones to RMT. 29 Sheard, The Passionate Economist, p 243. 30 Willmott, A Singular Woman, pp 134–​5, for Aves’s attempt to mediate between Titmuss and Younghusband; T. Philpot, ‘Robert Huws (Robin) Jones’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004; Titmuss, Problems, p 520, n 1. 31 TITMUSS/​2/​209, letter, 9 September 1965, Raison to RMT. 32 R.M.Titmuss,‘Foreword’, in A. Forder, Social Casework and Administration, London, Faber and Faber, 1966, pp 9–​10 (dated December 1965). 33 TITMUSS/​2/​209, letter, 14 March 1966, Seebohm to RMT. 34 TITMUSS/​2/​209, letter, 17 April 1966, Seebohm to RMT. 35 The following is based on TNA, HLG 12/​761, ‘Minutes of the Sixth Meeting of the Committee held at the Ministry of Housing and Local Government on Friday 15th April, 1966’, pp 1–​4. 36 R.M. Titmuss, ‘The Welfare Complex in a Changing Society’, The Milbank Memorial Fund Quarterly, 45, 1, 1967, pp 18–​19, 21–​2. Reprinted in Commitment to Welfare. 37 Secretary of State for the Home Department, Secretary of State for Education and Science, Minister of Housing and Local Government, Minister of Health, Report of the Committee on Local Authority and Allied Personal Services: Cmnd. 3703, London, HMSO, 1968. 38 R. Pinker,‘Social Work and Social Policy’, in M. Bulmer, J. Lewis, and D. Piachaud (eds), The Goals of Social Policy, London, Unwin Hyman, 1989, p 96; and R. Pinker, ‘Social Welfare and the Education of Social Workers’, in P. Bean and S. MacPherson (eds), Approaches to Welfare, London, Routledge and Keegan Paul, 1983, p 156. 39 TNA, HLG 120/​1103, Minutes of the Meeting of the Seebohm Committee, 30 June 1967, p 6. 40 E.M. Goldberg with A.  Mortimer and B.T. Williams, Helping the Aged:  A Field Experiment in Social Work, London, George Allen and Unwin, 1970, p 10; M.  Davies, ‘Tilda Goldberg:  A Pioneer Researcher in Social Work Studies’, The Guardian, 10 January 2005; MORRIS, JM/​14, Medical Research Council, ‘Progress Report of the Social Medicine Research Unit, 1948–​50’, p 1. 41 Goldberg et al, Helping, pp 12, 13, 14. 42 Ibid, pp 14, 15, 16 (emphasis added). 43 A. Oakley, Experiments in Knowing:  Gender and Methods in the Social Sciences, Cambridge, Polity, 2000, pp 250–​1.

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20 Commitment to Welfare and the Finer Committee on One-​Parent Families Introduction Titmuss’s working life was always a balance between what were, for him, the principal functions of higher education –​teaching students and conducting and disseminating research –​and engagement with the policy process. In his view, though, these activities were complementary, rather than existing in watertight containers. This chapter examines, first, the reception of his second collection of essays, Commitment to Welfare. Although based on existing writings, and subject to academic criticism, this book also had an explicitly educational function.Titmuss’s detailed, practical, contributions to the Finer Committee on One Parent Families is then described. This work was challenging and complex, raising a number of important questions about the aims and delivery of social services.

Commitment to Welfare Commitment to Welfare was published in 1968, in both Britain and the US. The American edition’s front cover posed two of the questions Titmuss had addressed:  ‘What can be done about the fundamental inequities of our society?’ and ‘How can our social policies benefit all sections the population rather than increase the power of the few?’1 The volume consisted of 21 pieces, and the essays, or the lectures from which they derived, are discussed at appropriate points in this volume. So here we examine why Titmuss brought out this collection, and the reaction to it. As he explained, while most of the pieces had been

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published, some were not easily available. Consequently, students had difficulty in locating them, while Titmuss’s secretary, the redoubtable Angela Vivian, was ‘sometimes over-​strained by the flow of requests for offprints, typewritten copies and the like’. Titmuss’s publisher at George Allen and Unwin, Charles Furth, had also employed his ‘gentle persuasiveness’ to bring the collection about. A similar rationale had been provided for Essays on ‘The Welfare State’. Commitment to Welfare was organised into four thematic sections. But this gave an ‘exaggerated impression of tidiness which I hasten to disavow’, as the more Titmuss tried to understand ‘the role of welfare and the human condition the more untidy it all becomes’.Among those thanked for their comments were Abel-​Smith and Townsend and, from the United States, Eveline Burns and Ida Merriam. In an enigmatic turn of phrase, ‘the aid, subjective and objective, of my wife’ was also acknowledged.2 By this account, Commitment to Welfare was primarily conceived as a tool for students and teachers of social welfare. This chimes with one of its essays. Addressing the Social Administration Association’s first meeting in July 1967, Titmuss affirmed his conviction that ‘the primary function of the university is to teach’, with its second, albeit complementary, role being the advancement of knowledge.3 But the collection was extensively reviewed, and so can be seen, too, as a measure of Titmuss’s standing at the time of its appearance. It also generated correspondence from friends and admirers. John Spencer, Professor of Social Administration at the University of Edinburgh (the post on which Titmuss had advised the university), told Titmuss that he had just bought the volume, which ‘looks an absolutely first class collection of essays’. He would enjoy reading it, ‘and of course see that people here read it too’.4 Without over-​analysing this pleasantry, this hints that the volume would be used in teaching, just as Titmuss wished. However we now focus on reviews which, to varying degrees, took issue with Titmuss. Such critiques will help inform our ultimate assessment of the strengths and weaknesses of his approach. Margot Jefferys, Professor of Medical Sociology at Bedford College, London, acknowledged that, in a telling phrase,‘for better or for worse’Titmuss and the ‘neo-​Fabian “school” ’ he led had had ‘a considerable influence, nationally and internationally, on the development of [Social Administration] as an academic discipline’. As such, they had ‘provided the reference framework for social policies of the political parties of the left and centre’. Focusing on the volume’s first section, ‘Social Administration: Teaching and Research’, Jefferys had been ‘struck by the eclecticism which still pervades his approach to the subject, as it did when he gave his inaugural lecture in 1950’.Titmuss retained ‘basically

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the historical approach used by his Fabian predecessors’, for instance the Webbs and Tawney. Jefferys conceded that Titmuss had borrowed approaches from other social scientists, and his essays reflected ‘the increasing use of sociological concepts in the subject matter of social administration’. His main contribution, therefore, had been to ‘synthesize such concepts in order to illuminate the choices, moral, social and economic, upon which social policies are founded’. More generally, Titmuss had come to realise the obstacles facing the achievement of the sort of welfare society he envisaged, not least the persistence of ‘nineteenth-​century ideas’ about the behaviour of the poor. Jefferys concluded that, over the preceding decade, Titmuss had ‘lost none of his capacity to take ideas from a variety of sources’, and to show that by ‘synthesizing them they can contribute to our understanding of the ideologies, structure and function of a community’s welfare agencies and the behaviour of their clients’.5 There was much that Titmuss might have been pleased about here. But Jefferys also raised points which can be seen as more critical. So, for example, it was true that Titmuss took a ‘historical approach’ to his subject matter. But this was, coming from a sociologist, not necessarily a compliment, notwithstanding that Jefferys herself had trained as an economic historian at the LSE under, among others, Tawney.6 And while some might have been flattered to be placed in the company of Tawney and the Webbs, for many 1960s sociologists the empiricism of especially the latter would have seemed very old hat, the terrain of ‘neo-​Fabian “school” ’ which Titmuss purportedly led (and note also the inverted commas Jefferys placed around ‘school’). It is worth remarking, too, that Jefferys stressed that what Titmuss was about was ‘synthesizing’. So what can be discerned here is the charge that Titmuss, and his followers, failed to develop a ‘theory’ of Social Administration, confining themselves instead to description, and morally based prescription. It is notable that Jefferys was later to compare Titmuss unfavourably with Barbara Wootton as a ‘social analyst’.7 Similar issues arose in Donald MacRae’s review, alluded to in Chapter 1, where it was also noted that the sociologist was an LSE colleague of Titmuss’s. He, too, had positive things to say.The volume’s coverage was ‘international’, its tone ‘at once earnest and conversational, literary and scientific  –​the range of reference is remarkable –​dispassionate and humane’. MacRae then quoted the journalist Bernard Levin (another LSE graduate) to the effect that ‘the Social Administration Department of LSE was the only one which had actually done some good’. MacRae attributed this to its ‘tutelary deities’, T.H. Marshall and Titmuss, having ‘unlike some others in this field …

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an inveterate habit of thought and of taking the larger view’. Titmuss had, moreover, ‘charisma, the power to create and inspire disciples’. His influence thus pervaded ‘policy-​making, research, teaching and practice in the whole field of our social services’. Such was his international reach that, when MacRae had recently spent time with social workers in California, ‘all they wanted to hear about was the Titmuss school’. So far, so good, and MacRae unreservedly commended the book. Nonetheless, what MacRae’s ‘Californian friends’ had described as the ‘Titmuss revolution’ still lacked ‘an elaborate exposition of the tacit sociology, methodology and value system’ which lay behind it.8 Again we have the charge that Titmuss’s work remained without, as yet, any theoretical underpinning. It will be recalled from Chapter 1 that MacRae, in this piece, contrasted the ‘Roundheads’ of Social Administration with the ‘Cavaliers’ of Sociology, and it was suggested that this could be seen as part of the perception of Titmuss as some sort of puritan ascetic. But there was more to it than this, with the implication that while sociologists were making daring forays into grand theory, Social Administration’s dour plodders were relentlessly involved in ‘applied’ work. This is not as fanciful as it might sound, given the struggles Titmuss had to slough off the image of his department as simply concerned with training social workers. Add to this the tensions between the respective departments at the LSE, and there were clearly grounds for mutual suspicion. Another mixed review, over three pages (including the front page) in The Times Literary Supplement, came from Titmuss’s erstwhile colleague, John Vaizey.Vaizey noted Titmuss’s aversion to ‘formal economic and sociological analysis’, for this reviewer,‘a drawback’. Due attention was paid to Titmuss’s ‘moral’ approach, but Vaizey argued that ‘in the long historical view’ Titmuss had underestimated what economic growth, and the expansion of the social services, had delivered. Overall,Titmuss had ‘achieved his present position in the field of social studies and social administration –​a small plot in that field –​by a combination of scholarship and broad intuitions, coupled with an attractive and subtle rhetoric’. Nonetheless, his was a ‘synthesizing mind, not an analytical one, and essentially his ideas are those of an impressionistic historian’. Notwithstanding the perception that Titmuss had ‘produced an up-​to-​ date socialist philosophy which is a powerful engine of criticism’, what he had actually delivered was ‘a vision of the world recommended by the quality of his rhetoric’. It was in ‘no sense an engine of criticism’.9 Once again, we have a view of Titmuss as a synthesiser, rather than an original thinker, with the added, no doubt hurtful, twist that, ultimately, his ideas did not provide a radical critique of contemporary society.

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Jefferys and MacRae were correct to identify Titmuss’s international reach. As we shall see in Chapter 24, Commitment to Welfare was extensively reviewed in the United States, where its reception was rather more positive than some of the British notices. Among the latter, that by the IEA’s Arthur Seldon was notably critical. Seldon’s review appeared in the recently founded Social Policy and Administration.Among the journal’s editorial team at this point were the economists Michael Cooper (who had a large part in its founding) and A.J. Culyer.10 As we shall see in Chapter 27, 1968 also saw the publication of the IEA pamphlet on the market in blood, jointly authored by Cooper and Culyer, which was in large measure an attack on Titmuss. For the conspiratorially minded, something was going on here. Titmuss was, Seldon began, the ‘doyen of post-​war academic social administration’, with a ‘formidable’ publication history. Whatever one thought of him, he would ‘leave his mark on the teaching of social administration for many years’. Titmuss would also leave his mark on social policy, ‘though it seems not for so long’, and on the ‘fortunes of the Labour Party that until recently sat at his feet’. What Seldon was probably getting at here was Titmuss’s increasing estrangement from certain colleagues over his role on the Supplementary Benefits Commission, and his public disagreement with the Labour government over immigration policy, both discussed in later chapters. The collection’s main purpose, though, was ‘to erect and defend the principle and philosophy of the universalist welfare state’. It was important to understand this, given Titmuss’s appointment to public bodies, his international reach, and the number of students taught by his department, a department which, by Seldon’s account, lacked intellectual diversity and any sense of self-​criticism. For the economist interested in welfare, all this provoked ‘unease as well as awe’, for if the present collection reflected the ‘degree of economic understanding with which the students left the Department it cannot have been very much’.‘Emotion’ was ‘no substitute for analysis, nor compassion for cost consciousness’, while Titmuss’s writing was often ‘interrupted by prose cloying with the cadences of compassion’, so that debating with him ‘makes his adversary feel not only wrong but also wicked’. Nor was there any clear sense of what actually constituted ‘Social Administration’, or how to analytically deal with, say, the question of ‘need’. Parts of the collection implied that Titmuss would not be happy until ‘everyone were living near the average and had as much welfare as everyone else’. In a particularly wounding comment, Seldon then asserted that ‘at these points the flavour of social science is replaced by that of romantic mysticism’. And, touching a raw nerve, Seldon claimed, correctly, that

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his adversary had shifted from unqualified support for universalist services to one also embracing selectivity. Concluding, Seldon remarked that the Second World War had given ‘Professor Titmuss his chance’. But he now seemed ‘out of his element in the freedoms, aspirations, diversities, and spontaneities of peace’.11 It is hardly surprising that Seldon was hostile but, equally, there can be no doubt that he raised serious issues about Titmuss’s approach. So, for instance, his apparently off-​hand comment about the Second World War does point to Titmuss’s claims for social solidarity on the Home Front, his disappointment with post-​war reconstruction, and his scepticism about ‘The Affluent Society’. But his hostility illustrates, too, that Seldon took Titmuss seriously, an opponent to be confronted and defeated. Nor was Titmuss an isolated prophet crying in the wilderness. He had expanded his base at the LSE with like-​minded colleagues, all of whom were influencing generations of students. Seldon’s comments are likewise a reminder that Titmuss and his colleagues had not only led the way in the development of Social Administration, they also had the ear of certain Labour ministers. We now turn to another example of Titmuss’s involvement with official enquiries set up by a Labour government, an illustration that Seldon’s suggestion of a falling out between Titmuss and the Labour Party was overstated (and probably mischievous).

The Finer Committee on One-​Parent Families In late 1969 Crossman, as Secretary of State for Health and Social Security, set up the Committee on One-​Parent Families. Morris Finer QC, also an LSE governor, was its chair. Titmuss was invited to join, and, in accepting, asked rhetorically ‘whether I have not enough to do at the present time’. But Finer had assured him that ‘as far as possible he will limit the calls on my time’. Titmuss was, therefore, ‘glad to accept [Crossman’s] invitation’.12 In fact Titmuss was, for the most part, an assiduous attendee at Committee meetings, and was appointed to its research subcommittee at the full Committee’s first meeting.13 He made important contributions to the Committee’s work, although in 1971 he told his colleague, Olive Stevenson, that he had often wished he had rejected Crossman’s invitation. Involvement with the Committee was both ‘immensely time consuming’ and, mysteriously, there were ‘other inhibiting difficulties which I can explain when we meet’.14 The Finer Committee was partly a response to the Labour government’s White Paper of January of that year which, as Pat Thane and Tanya Evans put it, sought a ‘radical … overhaul of the social

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security system’ as had first been suggested by Titmuss,Townsend, and Abel-​Smith a decade earlier. The White Paper had also proposed the setting up of an enquiry into how best to aid one-​parent families and, more generally, their position in society.15 As Jane Lewis points out, the Committee was appointed at a time when the number of illegitimate births was beginning to rise rapidly, changes in divorce law meant both that there was the potential for more single-​parent households and that changes were taking place in public attitudes towards sexual morality, and ‘it was becoming obvious that the gap between the standard of living of one-​and two-​parent families was growing’.16 Campaigning voluntary bodies such as the National Council for One Parent Families (NCOPF) had long lobbied for such an enquiry, and welcomed its creation.Thoughtful Labour politicians likewise flagged up the issue. Around the time of her appointment, in 1967, as Minister for Social Security, Judith Hart argued that the ‘fatherless family is an example of a problem presenting itself because of our changing social structure’. So what was to be done about ‘unmarried mothers, and deserted, separated or divorced wives beyond offering them child dependants’ allowances and supplementary benefit if necessary’?17 Significantly, though, the Child Poverty Action Group was more sceptical about Finer. Although it had argued for more help for one-​parent families, it declared itself unclear about the Committee’s purpose, and why it had taken so long in setting up.18 CPAG did not give evidence to the enquiry, and its attitude needs to be borne in mind when, in a later chapter, we discuss the falling out between Titmuss and Townsend, alongside the CPAG’s critique of the SBC. Because of the 1970 general election’s unexpected outcome, the bulk of the Committee’s work was done under a Conservative administration, although by the time it came to report, in 1974, Labour had returned to power. Apart from Titmuss, other members included O.R. McGregor, Professor of Social Institutions at Bedford College, and, according to Oakley, her ‘father’s friend and ally in university business’. The Daily Mirror ‘agony aunt’ Marjorie Proops was also a member, as was Barbara Kahan, Children’s Officer for Oxfordshire at the time of appointment. Kahan, like Titmuss, had been involved with Common Wealth in the early 1940s, before taking a diploma in social science at the LSE. If not actually acquainted, it seems likely that she and Titmuss would have been aware of each other for some time.19 Thane and Evans contend that Finer’s findings and proposals constituted the ‘most thorough description and analysis of the situation of lone-​parent families of the twentieth century’, and that, while not all its recommendations were implemented, nonetheless ‘it led to

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significant changes in benefits, housing, and, probably, public attitudes’, as well as having a ‘long-​term impact on the legal system’.20 Lewis is more sceptical. She acknowledges that Finer ‘broke with past analyses of the problem of lone motherhood in many significant respects’, and that it then logically followed that ‘the burden would have to be borne by government in supporting lone-​mother families’. But opposition soon came from, most notably, the Department of Health and Social Security (DHSS), while the Commons debates on the report were ‘desultory’. As to Titmuss, Lewis finds him sharing the DHSS standpoint that lone-​parent families should remain on supplementary benefit, and attributes his hostility to some of the more radical proposals brought before the Committee to ‘his lack of sympathy with lone-​mother families’. Ultimately, then, the Finer Report was not fully implemented, although ‘changes along the lines of those recommended by Titmuss did take place’.21 Clearly these were complex matters. Here we focus on two issues with which Titmuss was notably engaged, bearing in mind that he died before the Finer Committee completed its work. These are income maintenance, and especially Educational Maintenance Allowance (EMA), and the international dimensions of the Committee’s work. This allows us insight into Titmuss’s attitudes towards welfare provision and social policy research in the last few years of his life. More especially, they highlight controversial topics such as selectivity in welfare provision. On one level, Titmuss was a committed universalist who believed that benefits should be given without means testing, and without what was seen as associated stigma and judgementalism. Did, then, his engagement with the Finer enquiry contribute to a change of position?

Income maintenance Income maintenance was a key, if challenging, issue for the Committee. As John Veit-​Wilson remarks, it is ‘not a precise term’, but roughly speaking embraces ‘those state provisions which enhance the capacity to earn an income, or narrowly those which sustain a level of income or reduce living expenses when normal sources fail’. Moreover, state policies in areas such as education or health may, deliberately or otherwise, ‘enhance some people’s earning capacities’.22 It is notable that many of the campaigning groups active in the 1960s, for example CPAG and NCOPF, and, from its creation as a single-​parent self-​help group in 1970, Gingerbread, saw themselves as especially concerned with income maintenance. In a revealing phrase, such bodies were often

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referred to as part of the ‘poverty lobby’, and we shall see in Chapter 25 that for some Titmuss, too, was part of this group. In turn, this reminds us that the 1960s saw, thanks in large part to campaigning groups like CPAG and NCOPF, the so-​called ‘rediscovery of poverty’, an issue to which the Labour government of 1964–​70 was politically sensitive.23 While income maintenance is undoubtedly a rather opaque concept, it nonetheless had meaning in the late 1960s and 1970s to those who sought its consolidation and enhancement. And there can be little doubt that by the late 1960s income maintenance schemes involved a large proportion of public expenditure on welfare. Titmuss himself had given a potentially challenging account of income maintenance in a 1967 speech. Here he had posed a series of questions. Should income maintenance programmes be conditional on recipients’ use of certain services in kind, for example rehabilitation, ‘because we wish to maximise the effectiveness of all the services involved?’ Slightly refocusing this point, should ‘income maintenance be “wasted” on consumers who may take no steps to change their circumstances, improve their health and ways of life?’There was thus a ‘conflict … between the concept of effectiveness and the rights of the consumer to certain services irrespective of their morals and patterns of behaviour’. How this was resolved was, ultimately, a moral question depending on ‘how the scales are weighed between the rights of the individual and the rights of society’.24 Titmuss thus raised the question of selectivity without, at this point, engaging with it directly. Nonetheless, he also continued to rail against the welfare system’s complexities. In 1970, the new Conservative government introduced Family Income Supplement (FIS), a means-​tested benefit. For Titmuss, this simply added to ‘The great poverty muddle’, and FIS would make 1971 ‘a record year for means-​testing’.As such, it signalled the ‘death of all the romanticism invested in recent years, on the political left as well as the political right, in the presumed simplicity of negative income taxation’.Titmuss was here alluding to welfare’s Holy Grail, an integrated tax and benefit system.The scheme would be open to misunderstanding and misinterpretation, and those to whom it applied, ‘the poorest of the working poor with irregular incomes, distraught, bewildered and in need of health and welfare services of many kinds –​already inhabit an involved world of means-​testing’. Welfare policy in America was leading to the ‘polarising of their society into two groups, the poor and the non-​poor, the means-​tested and the non-​means-​tested, black and white’. Should Britain, then, ‘not do everything possible to avoid a similar polarisation?’ One of the few crumbs of comfort was that ‘Fatherless families with the mother in full-​time work at shockingly

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low wages will clearly gain most from this scheme’. What is revealing, though, is that Titmuss did not call for an end to means testing. Perhaps accepting the inevitable –​the Conservatives had long viewed means testing as a method of reducing welfare expenditure and incentivising the workforce –​he merely called for a ‘comprehensive guide to all the new, revised and existing means-​tests’.25 Income maintenance was complicated not least because of the range of benefits available. One in which Titmuss had a longstanding interest, and which entered the Finer discussions on a number of occasions, was EMA, and Titmuss’s approach to this issue is used to illustrate more general points about his views on social security. As the Finer Report was to put it, EMAs were ‘available to low-​ income families where children stay on at school beyond age 16’.26 A Ministry of Education Working Party had reported on the scheme in 1957, but Titmuss was clearly not impressed, writing comments such as ‘Primitive Essay in Social Policy’, and ‘Why No Reference to University Scales?’, on his own copy of the document.27 Titmuss raised the issue of EMAs in the second of two articles for The Times in 1965. Both were concerned with a more equitable treatment for families with children in the context of, as the first piece explained, a ‘population explosion’ and a ‘remarkably generous pronatalist policy for a section of [the British] population’ (essentially tax breaks and benefits for the better off). This was in contrast to the ‘accumulating evidence of hardship among substantial numbers of children of low wage-​earners, fatherless families, and other handicapped parental categories’. Titmuss returned to fatherless families in the second piece, noting that, in common with other types of deprived families, the ‘present income maintenance services’ were helpful but, nonetheless, ultimately ‘ineffective in enabling them to break out of the vicious circle of inherited poverty’. Benefits such as EMAs had, moreover, ‘degenerated into little more than token payments’.28 Before the Finer Committee was set up, therefore, Titmuss was aware of the issues facing one-​parent families. Significantly, 1965 also saw the publication of Abel-​Smith and Townsend’s The Poor and the Poorest, which showed what the authors called their study’s ‘most novel finding’, namely the ‘extent of poverty among children’, such that there were ‘more children in poverty than adults of working age’.29 Titmuss would have been well aware of this work and its findings, having read it in draft, and being chair of the Editorial Committee of the series in which it was published. Titmuss kept up his interest in EMAs. Peter Shore raised the issue with the Education Secretary,Anthony Crosland, also in 1965. Shore sought information on the volume of local authority

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expenditure on these allowances, the strategy they adopted, and the costs incurred providing students with higher education.30 This has a very Titmuss feel to it, given his (justifiable) claim that university students, and their parents, were beneficiaries of high levels of expenditure, and various forms of tax relief. Shore, writing to Titmuss with copies of Crosland’s replies, noted that local authority expenditure on ‘maintenance allowances is ludicrously, shockingly small’.31 A few years later, when the Finer Committee was deliberating,Titmuss continued his quest for up to date information. Another Labour MP, Michael Meacher, also raised the issue in Parliament in spring 1971, but he had to tell Titmuss that the answers were not very helpful.32 Some months later Titmuss asked his colleague, David Piachaud, whether any work was being done on EMAs but, revealingly, Piachaud answered in the negative.33

Contributing to the Committee These frustrations notwithstanding, by the time of the Finer Committee Titmuss had identified EMAs as a potentially valuable, although not unproblematic, benefit.The report was to confirm that there were ‘wide variations in local authority practice’ in terms of amount awarded, in the levels of parental income allowing for qualification for the scheme, and in the scales which determined the reduction in allowance as parental income increased. And while most authorities applied the same test to one-​parent as to two-​parent families, ‘a number were treating one-​parent families less generously on the grounds that the family’s needs were reduced by the absence of one adult’.34 These were among the issues with which Titmuss, and the Committee, grappled. In the wake of a weekend-​long meeting in November 1971, he composed a memorandum suggesting that ‘the Committee will wish to recommend national mandatory income scales and rates of grant payable by all local education authorities’, and that it should consider the possibility of extending the scheme to include children aged 14 to 16 in one-​parent families.35 A few weeks later, he told the research subcommittee that EMAs were ‘a very valuable and important source of income as they were completely disregarded for supplementary benefit purposes’.The value of the latter, that is, remained unchanged. Therefore the Committee would undoubtedly feel ‘that it was time that these allowances were established at a national and mandatory level’. And it might also want to recommend that the qualifying age for children be reduced, and consider whether such recommendation should apply to all families, or only one-​parent families.36

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Also in late 1971, Titmuss asked the Finer Committee’s secretary, G.C.F. Sladden, to look into comparisons between EMAs and the resources made available to direct grant grammar schools  –​that is, schools which were not controlled by local authorities, could enrol fee-​paying students, but received a subsidy from central government. Sladden told him that the basis of fee remission for direct grant schools was ‘not regarded as designed to measure hardship in the same sort of way as the scales for awarding EMAs, free school meals or such-​ like benefits’. There was no direct relationship between the different schemes, nor had there ever been. Exercising due Civil Service caution, he concluded that direct grant fee remission and EMAs were ‘sufficiently different in their nature and purpose to make it difficult to construct a cut-​and-​dried argument that such a provision in one respect implies that there should be such and such a provision in the other’.37 For Titmuss, though, the point was, undoubtedly, that a privileged form of educational provision was being financially underwritten in a manner not available to those less advantaged. Lack of information notwithstanding, Titmuss ploughed on. In advance of a research subcommittee meeting in spring 1972 to discuss ‘Income Maintenance’, he listed a series of discussion points. He was ‘convinced of the need to explore the possibilities of EMAs’. Returning to a point he had raised previously, these could be ‘made mandatory nationally and on a more generous mean-​tested basis’. Again revisiting a previous suggestion, the age of entitlement could be lowered to 12 for all one-​parent families (possibly even to all families), with, potentially, a higher scale for the 16 to 18 age range.38 Later that year,Titmuss made a major contribution to Finer’s deliberations on income maintenance. It was noted that ‘Professor Titmuss said that a lot of information had been obtained about EMAs’ –​presumably by him. The scheme was ‘archaic and ought to be changed’, and there was a danger that ‘the cycle of deprivation among unmarried mothers and their children would be perpetuated if girls were not encouraged to continue their education’.The Committee agreed with his suggestion that ‘there should be a national mandatory scheme financed by central government’.39 This made its way into the report, which stated that the Committee did not accept that access to EMAs should be partly determined by where an individual family happened to live. Consequently, ‘educational maintenance allowance schemes should be rationalised on a national basis, with standard scales of allowances and qualifying parental income’.40 It is worth pausing to make three points. First, it would be absurd to suggest that Titmuss was solely responsible for Finer’s stance on EMAs. Nonetheless, he devoted a considerable amount of thought to

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the issue, and the Committee looked to him as an authority on income maintenance in general. Shortly before his death, the senior research officer wrote to Titmuss complaining about a recent meeting’s lack of clarity, and structure. Essential points such as ‘precisely who benefits and who precisely bears the cost –​and many others –​are not touched upon’. Titmuss’s ‘own presence in this respect’ was, therefore, ‘sadly missed’.41 This official was certainly an admirer. Immediately after the December 1972 meeting, he told Titmuss that he, ‘in common with others’, had been ‘little short of spellbound by what can only be termed a masterly presentation of the paper on Monday’. Those present had received a ‘rare lesson’ in how to ‘handle the committee’.42 It is therefore not unreasonable to see Titmuss’s contribution, especially on EMAs, as influential. Second, Titmuss had left the way open to introduce selectivity into income maintenance, and his deliberations on Finer reinforced this already existing trend.This will be returned to in the final chapter, when we attempt to assess the evolution of Titmuss’s ideas over the course of his career. Third, we have the phrase ‘cycle of deprivation’. Earlier in 1972 the Secretary of State for Health and Social Services, Sir Keith Joseph, had made a speech on this subject. As John Welshman shows, Joseph was particularly concerned about the possibility that ‘problem families’ might reproduce themselves over successive generations. Joseph acknowledged that poverty could be a contributory factor, and that, consequently, welfare spending would need to be increased. But he also argued that ‘inadequate people tend to be inadequate parents and … inadequate parents tend to rear inadequate children’. The cycle of deprivation could, then, be seen as resulting from both structural and behavioural factors. Putting all this in a broader context Joseph asked, just as campaigners such as the CPAG had been asking but from a different standpoint, why it was that, notwithstanding long periods of full employment, the expansion of social services, and relative prosperity, ‘deprivation and problems of maladjustment’ persisted, and ‘conspicuously’ so.43 Titmuss was contributing to a contemporary debate about deprivation, and its possible transmission through the generations, and, as we have seen, had used the expression ‘vicious circle of inherited poverty’ in one of his articles for The Times in 1965. He clearly thought that such a process could occur, and that lack of educational opportunity could play its negative role. Intriguingly, one of Titmuss’s colleagues, Howard Glennerster, later recalled that Titmuss had influenced Joseph’s thinking, and that there had been contact between them in the early days of the 1970–​74 Conservative government. And although this

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seems counterintuitive, Glennerster also suggests that Joseph would have regarded Titmuss as ‘above the fray’, and that there was no reason why he should not have approached him for advice.44

International comparisons In early 1970, the Committee recorded that its recently established research subcommittee had discussed examining provision for one-​parent families in other countries, and had begun negotiations with the Geneva-​based International Social Security Association (ISSA).45 A formal approach to ISSA, a body with which Titmuss was well acquainted, was made shortly afterwards, with the Committee secretary writing to the Association’s Secretary General, Leo Wildmann. The official told Wildmann that a member of ISSA staff, Christine Cockburn, had recently met with the subcommittee, and that the Committee was interested in ‘information on the cash benefits, direct and indirect, available for one-​parent families, in particular for unmarried, separated and divorced mothers’. It was ‘especially concerned to understand the social purpose of these provisions, and to learn how they work out in practical operation’.46 Titmuss was behind all this.A few weeks later,Wildmann told him that, following ‘your kind mediation’, the Committee and the Association had agreed that the latter ‘should undertake a study of the arrangements in other countries for one-​parent families’. This was a ‘very important new development’ for ISSA’s research activities, and Wildmann was ‘extremely grateful to you not only for making the initial proposal but for steering the negotiations and helping shape the agreement’.Titmuss went to some trouble over this, with Wildmann also thanking him for the ‘particularly pleasant reception’ at the LSE and asking that he ‘convey our appreciation to the Director … for his kind hospitality’. It had been a ‘great pleasure’ to meet ‘in such a delightful and friendly atmosphere, social security colleagues’, both administrators and academics. Overall, ‘these meetings and social gatherings have helped to make ISSA better known in the United Kingdom social security world’.47 The ISSA’s principal researchers on this project were, first, Cockburn, formerly of the LSE, whom Oakley remembers as one of a number of women from the School who visited the Titmuss home to experience ‘my mother’s economical dinner parties’.48 In January 1971, the ISSA produced an interim report, compiled by Cockburn, on provision for one-​parent families in other countries. Over half a dozen had already been looked at, with Norway and Hungary being selected, at this early stage, for separate reports. It was also proposed that West Germany and the other Scandinavian nations would ‘merit attention’.49 Cockburn

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herself attended the research subcommittee meeting where this document was presented, with Finer observing that it ‘raised many important questions in members’ minds’. Summing up, the chairman suggested that all agreed the need to concentrate on Scandinavia and West Germany, with reference made to other nations where appropriate.50 The other researcher, employed specifically for the project, was Hugh Heclo, an American who had arrived in England in 1967 to make a comparative study of British and Swedish income maintenance policies. Ultimately, this became Modern Social Politics in Britain and Sweden.51 By 1970, he was a lecturer at the University of Essex, and clearly known to Titmuss. Titmuss made notes of a meeting between them in late 1970, commenting that the American was ‘still interested when he finishes at Essex in the Geneva Research project’, and that he would introduce him to Ida Merriam on her visit to London two months hence.52 We encounter Merriam, a prominent figure in American social welfare, more fully in later chapters. But for present purposes, what is important is that she was well connected with ISSA, being, for example, chair of its Study Group on Social Security Research.53 In spring 1971, Cockburn confirmed Heclo’s appointment, specifically to look at provision in the Scandinavian countries, with Titmuss relaying this to the research subcommittee a few weeks later.54 Titmuss was thus instrumental in Heclo’s engagement. In summer 1971, he reported to the research subcommittee that Heclo had produced a report on Denmark, Norway, and Sweden.This document was ‘excellent’, particularly given ‘the time limitations which were imposed’.55 Heclo’s report was also praised by Finer himself.56 The outcome was an appendix to the Finer Report, ‘Income Maintenance for One-​Parent Families in Other Countries: An Appraisal by Christine Cockburn and Hugh Heclo’. This focused primarily on West Germany and the Netherlands, analysed by Cockburn, and Norway, Sweden, and Denmark, analysed by Heclo.57 A longer version also appeared in the ISSA’s journal.58 This research was clearly important to Titmuss, partly because of its comparative nature.As the Finer Committee began to solidify its proposals, he told colleagues that comparing these with ‘provision in other countries for one-​parent families caused him to believe that they would be regarded as the most forward looking and imaginative in the world’.59

Titmuss and lone mothers Finally, what of Lewis’s claim that Titmuss lacked sympathy with lone-​ mother families? This complex issue also has to be seen in the context of Titmuss’s defence of the SBC, discussed in Chapter 25. But some

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clues to his approach can be discerned from his Finer Committee activities. He was exercised, for instance, about the issue of equity. In late 1970, as part of a broader discussion with DHSS officials about the SBC, Titmuss noted that there were issues around ‘disregard’, that is, the level of income an individual might acquire without state benefits being affected (in this particular case, it is earnings disregard which is particularly important). An increase in the level of earnings disregard ‘might (for the unsupported mother at least) provide greater freedom of choice to take up part-​time as opposed to full-​time work’. But could the exclusion of other groups, such as pensioners, be justified? There was also ‘the problem of whether it would be proper to offer too strong an incentive to work part-​time to the mother of very young children’.60 Just over a year later, Margaret Wynn gave evidence, written and oral, to the Finer Committee, appearing in person in February 1972 when she was introduced as a ‘pioneer in the field of reform for one parent families’.61 Wynn, Lewis observes, promoted the idea of an insurance-​based benefit, Fatherless Families Allowance (FFA), ‘albeit stretched to include unmarried mothers on a non-​contributory basis’. As such, her proposal ‘favoured those women who entered the labour market, something to which the Finer Committee objected’.62 Titmuss’s questioning of Wynn focused on the issue of equity, contrasting ‘women with entitlement to FFA and those with husbands who were chronically sick or disabled or who had been self-​employed and were not entitled to sickness benefit’.63 A few weeks later, Titmuss revisited equity. He was ‘convinced … that there must be a cash payment for the first child’, in other words an expansion of the allowances given to families with children. On the other hand, he was ‘persuaded that such payments cannot be restricted to [one-​parent families]’.Throwing yet more factors into the mix, this was for ‘a complex of reasons (including administrative simplicity)’.64 Shortly afterwards, in a Committee meeting in April 1972, Titmuss raised the question of selectivity when discussing ‘Charges for Day-​ Care’, in respect of support provided by local authorities. This should be free were the need a ‘social one (eg the mother’s sickness)’. But if day care was used ‘to increase the family’s income, then it was arguable that a charge was justifiable’, for not all one-​parent families were poor. Titmuss got himself into something of a muddle, though, when trying to untangle what would be, at least in his view, best for lone mothers. Most one-​parent families were headed by women. Not all, however. So ‘wherever possible a man should have the choice of working and he should not be forced to stay at home because of failure to provide supporting services for the family’. Any child-​centred policy would be

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enhanced if ‘the father was at work like other fathers’. But in some areas ‘local authority arrangements were so inadequate’ that men were forced to stay at home, and to claim supplementary benefit. But for women, supplementary benefit gave them ‘the choice of staying at home’, although this was largely because of women’s lower average wages. Lower benefit rates, though, would mean that women would ‘derive an obvious increase in income from working’. It was a ‘depressing fact’ that in deprived and rural areas women had few work opportunities. Education and training provision should be enhanced by, for example, courses in ‘shorthand and hairdressing’.These would ‘enable women to acquire skills and obtain jobs other than in domestic service’. Part-​time courses ‘geared to the circumstances and needs of women’ should be organised so as to ‘fit in with family responsibilities’.65 Ultimately, it is no surprise that, shortly before his death, Titmuss told the Committee that there was ‘no place, either the long or short term, for an unconditional one-​parent family benefit’, such as FFA. Reflecting, in part, the point noted earlier about the Committee’s sensitivities to changing social attitudes, its ‘income maintenance recommendations should be so framed as to be neutral to issues of marriage, marriage breakdown and reconciliation’, and there should be ‘neither incentives nor disincentives to marriage or divorce, above all in the interests of the children’. Based on his SBC experience, though, he thought that the need for a supplementary benefits scheme would remain ‘to meet exceptional and unusual needs’, and he argued, too, that the rates payable to lone parents and married couples should be the same.66

Conclusion A second edition of Commitment to Welfare was published in 1976, again by George Allen and Unwin, with an introduction by Abel-​Smith, who claimed that the original work, although ‘not written for this purpose’, had ‘become a basic text book on Social Policy and Administration’. Students were often advised to read it early in their studies, for it said ‘so much of fundamental importance in one highly condensed volume’. After summarising the contents, Abel-​Smith concluded that he had undoubtedly oversimplified the questions Titmuss posed, and the book had to be ‘read more than once to see just how complex these questions really are’.67 But Abel-​Smith was surely correct in his assessment of its overall impact on the field of social policy, its centrality for students, and its identification of issues, some of which continue to exercise academics and policy makers to this day. As to complexity, the

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Finer Committee is an example of how challenging social policy analysis can be. Here, even Titmuss seems to have been overwhelmed on occasions. Suggesting that women gain access to courses in shorthand and hairdressing may have been practical, given the circumstances, but it hardly shows vision or dynamic thinking.And while Lewis may have been overcritical of his approach to one-​parent families, when these were headed by women his ideas were not unambiguously sympathetic. Notes 1 R.M. Titmuss, Commitment to Welfare, New York, Pantheon Books, 1968. 2 R.M.Titmuss,‘Preface’, in R.M.Titmuss, Commitment to Welfare, London, George Allen and Unwin, 1968, pp 7–​8. The four thematic sections are, first, ‘Social Administration: Teaching and Research’.This contains the chapters ‘The Subject of Social Administration’ (noted in Chapters 19 and 20 of the present volume), ‘The University and Welfare Objectives’ (Chapters 18, 28), ‘The Relationship between Schools of Social Work, Social Research and Social Policy’ (Chapter 19), and ‘Time Remembered’ (Chapter  10). Second, ‘The Health and Welfare Complex’.This contains ‘The Relationship between Social Security Programmes and Social Services Benefits: An Overview’ (Chapter 29),‘The Welfare Complex in a Changing Society’ (Chapter 19),‘Social Work and Social Service: A Challenge for Local Government (Chapter 19), ‘Planning for Ageing and the Health and Welfare Services’ (Chapters 15, 19, 30), and ‘Community Care: Fact or Fiction?’ (Chapter  17). Third, ‘Issues of Redistribution in Social Policy’. This contains ‘Universal and Selective Social Services’ (Chapters 23, 25), ‘Welfare State and Welfare Society’ (Chapter 30), ‘Choice and the “Welfare State” ’ (Chapter 27), ‘Social Policy and Economic Progress’ (Chapter 23), ‘Child Poverty and Child Endowment’ (Chapter  20), ‘Models of Redistribution in Social Security and Private Insurance’ (Chapter 26), ‘The Role of Redistribution in Social Policy’ (Chapter 23), and ‘Pensions and Public Servants: A Study of the British System’ (Chapter 13).And, finally,‘Dilemmas in Medical Care’.This contains ‘The Role of the Family Doctor Today in the Context of Britain’s Social Services’ (Chapter 17), ‘Sociological and Ethnic Aspects of Therapeutics’ (Chapter 24), ‘Trends in Social Policy: Health (Chapter 27), and ‘Ethics and Economics of Medical Care (with postscript) (Chapter 27). Some chapters were retitled, or otherwise amended, before re-​publication. 3 Titmuss, ‘The Subject of Social Administration’, in Commitment to Welfare, p 18. 4 TITMUSS/​7/​76, letter, 3 September 1968, Spencer to RMT. 5 M. Jefferys, The British Journal of Sociology, 20, 1, 1969, pp 109–​11. 6 M. Stacy, ‘Margaret (Margot) Jefferys’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 7 Cited in Oakley, A Critical Woman, p 3. 8 D. MacRae, ‘Roundheads’, New Statesman, 1 July 1968, pp 175–​6. 9 Anon (but J. Vaizey), ‘Welfare and Diswelfare’, The Times Literary Supplement, 15 August 1968, pp 1–​3. 10 M. Powell,‘Social Policy and Administration: Journal and Discipline’, Social Policy and Administration, 40, 3, 2006, pp 233–​4, 240. 11 A. Seldon, Social Policy and Administration, 2, 3, 1968, pp 196–​200. 12 TITMUSS/​4/​634, letter, 21 October 1969, RMT to Crossman.

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Commitment to Welfare and the Finer Committee on One-​Parent Families 13 FINER, FINER 1/​1a, Minutes of the First Meeting, 11 December 1969. 14 TITMUSS/​4/​567, letter, 23 December 1971, RMT to Stevenson. 15 P. Thane and T.  Evans, Sinners? Scroungers? Saints? Unmarried Motherhood in Twentieth-​Century England, Oxford, Oxford University Press, 2012, pp 129–​30. 16 J. Lewis, ‘The Problem of Lone-​Mother Families in Twentieth Century Britain’, Journal of Social Welfare and Family Law, 20, 3, 1998, p 265. 17 HART, Hart/​11/​11, undated, but 1967, typescript J. Hart, ‘Social Security in a Situation of Growth: Accurate Recognition of Poverty’, pp 2–​3. 18 ‘Inquiry into One-​Parent Families’, The Guardian, 7 November 1969, p 22. 19 Oakley, Father and Daughter, p 200; T.  Philpot, ‘Barbara Joan Kahan’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 20 Thane and Evans, Sinners?, pp 140–43, 161, 167–​8. 21 Lewis, ‘The Problem’, pp 271–​2. 22 J. Veit-​Wilson, ‘Income Maintenance, Principle of ’, in T.  Fitzpatrick (ed), International Encyclopedia of Social Policy, London, Routledge, 2006,Vol 2, pp 638–​9. 23 See P.F.Whiteley and S.J.Winyard, Pressure for the Por: The Poverty Lobby and Policy Making, London, Methuen, 1987, pp 1, 53, and passim;The National Council and Gingerbread merged in the mid-​1970s having already established a cooperative relationship, including in their dealings with Finer: Thane and Evans, Sinners? Scroungers? Saints?, p 144. 24 R.M.Titmuss,‘The Relationship between Social Security Programmes and Social Security Benefits: An Overview’, International Social Security Review, 20, 1, 1967, p 65. Reprinted in Commitment to Welfare. 25 R.M.Titmuss,‘The Great Poverty Muddle’, The Guardian, 29 October 1970, p 13. 26 DHSS, Report of the Committee on One-​Parent Families Cmnd 5629, London, HMSO, 1974,Vol 1, para 5.313. 27 TITMUSS/​4/​632, Ministry of Education, Report of the Working Party on Educational Maintenance Allowances, London, HMSO, 1957, handwritten comments by RMT on cover. 28 R.M.Titmuss,‘Child Endowment Reappraisal’, The Times, 4 October 1965, p 11; and ‘Plan for Children in Poverty’, The Times, 5 October 1965, p 11. Reprinted as ‘Child Poverty and Child Endowment’, in Commitment to Welfare. 29 B.Abel-​Smith and P. Townsend, The Poor and the Poorest: Occasional Papers in Social Administration No 17, London, G. Bell and Sons, 1965, p 65. 30 BPP, House of Commons Debates, Fifth Series,Vol 715, 2 July 1965, cols 132–​4. 31 TITMUSS/​4/​632, letter, 5 July 1965, Shore to RMT. 32 TITMUSS/​4/​640, letter, 22 April 1971, Meacher to RMT. 33 TITMUSS/​4/​637, letter, 15 December 1971, Piachaud to RMT. 34 DHSS, Report of the Committee on One-​Parent Families,Vol 1, para 5.314. 35 TITMUSS/​4/​637, RMT, Memorandum,‘Educational Maintenance Allowances’, 30 November 1971. 36 TITMUSS/​4/​637,‘Minutes of a Meeting of the Research Sub-​Committee Held on 15th December 1971’, p 3. 37 TITMUSS/​4/​637, letter, 16 November 1971, Sladden to RMT. 38 TITMUSS/​4/​637, RMT, ‘Finer Research Sub-​Committee –​9th March ’72 –​ Income Maintenance’, 3 March 1972, p 3 (emphasis added). 39 FINER, FINER 1/​1c, Minutes of a Meeting Held on 18th December 1972’, p 4. 40 DHSS, Report of the Committee on One-​Parent Families,Vol 1, paras 5.317 and 5.318. 41 TITMUSS/​4/​634, letter, 2 March 1973, Dr L.G. Wooder, Finer Committee, to RMT.

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RICHARD TITMUSS 42 TITMUSS/​4/​638, letter, 21 December 1972, Wooder to RMT. 43 J.Welshman, Underclass: A History of the Excluded since 1880, London, Bloomsbury Academic, 2nd edn 2013, pp 125, 121–​2, and Ch 6 passim. 44 LSE, Department of Social Policy, Oral History Project, Professor Howard Glennerster interviewed by Sonia Exley, 23 April 2013; Howard Glennerster interviewed by author, 7 October 2015. 45 FINER, FINER 1/​1a, Minutes of the Second Meeting, 22 January 1970. 46 TITMUSS/​4/​633, letter, 28 January 1970, D.G. John to Wildmann. 47 TITMUSS/​4/​633, letter, 28 February 1970, Wildmann to RMT. 48 Oakley, Father and Daughter, pp 116–​17. 49 FINER, FINER 1/​3 g, ISSA, ‘Interim Report on Recent Social Policy Developments in Relation to One-​Parent Families’, January 1971, p 28. 50 TITMUSS/​4/​633, Minutes of a Meeting of the Research Sub-​Committee, 28 January 1971, pp 1 and 3. 51 H. Heclo, Modern Social Policies in Britain and Sweden:  From Relief to Income Maintenance, New Haven, CT,Yale University Press, 1974, p ix. 52 TITMUSS/​4/​633, RMT, ‘Note of a Talk with Hugh Heclo, 9th November 1970’, p 1. 53 See, for example, ‘ISSA Conference on Social Security Research’, International Social Security Review, 23, 2, 1970, pp 219–​23. 54 TITMUSS/​4/​633, letter, 15 April 1971, Cockburn to Sladden; and TITMUSS/​ 4/​636, Minutes of the Research Sub-​Committee, 10 May 1971, p 1. 55 TITMUSS/​4/​635, Minutes of a Meeting of the Research Sub-​Committee, 20th October 1971, p 2. 56 TITMUSS/​4/​633, letter, 2 November 1971, Finer to Heclo. 57 DHSS, Report of the Committee on One-​Parent Families,Vol 2, Appendix 3. 58 ‘Income Maintenance for One-​Parent Families: Report of a Research Project Undertaken by the General Secretariat of the International Social Security Association for the British Committee on One-​Parent Families’, International Social Security Review, 28, 1, 1975, pp 3–​60. 59 FINER, FINER 1/​1c, Minutes of a Meeting Held on18 December 1972, p 5. 60 FINER, FINER 1/​1a, Minutes of the Tenth Meeting, 2 November 1970. 61 DHSS, Report of the Committee on One-​Parent Families,Vol 2, Appendix 1; FINER 1/​1b, Committee on One-​Parent Families –​Oral Evidence from Mrs Margaret Wynn, 9 February 1972, p 1. 62 Lewis, ‘The Problem of Lone-​Mother Families’, p 271. 63 FINER, FINER 1/​1b, Committee on One-​Parent Families –​Oral Evidence from Mrs Margaret Wynn, 9 February 1972, p 2. 64 TITMUSS/​4/​637, ‘Finer Research Sub-​Committee –​9th March ’72 –​Income Maintenance’, 3 March 1972 (emphasis in the original). 65 FINER, FINER 1/​1b, ‘Committee on One-​Parent Families  –​ Paper on Employment and One-​Parent Families –​Detailed Record of Discussion at 41st Meeting, 24th April 1972’, pp 5, 6, 2. 66 FINER, FINER 1/​1c, Minutes of a Meeting Held on 18 December 1972, p 2. 67 B. Abel-​Smith, ‘Introduction’, in Titmuss, Commitment to Welfare, 2nd edn 1976, pp 5, 10.

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21 Titmuss and North America: early encounters and first visit Introduction We have encountered Titmuss’s engagement with Africa and with Israel, and, in an era when travelling abroad was not as easy as it later became, he attended meetings in various European countries. He also became an especially notable visitor to the United States, and it was primarily with American colleagues that he built up transnational policy networks. In later chapters, it is argued that Titmuss had an impact on US thinking on social policy, and we have already encountered the favourable review of Essays on ‘The Welfare State’ by one of America’s leading liberal intellectuals, J.K. Galbraith, and of Problems of Social Policy by the American authority on public health, George Rosen.A number of Titmuss’s American contacts became close personal friends. This chapter discusses his early engagement with the US, culminating with his first visit, in 1957.

Making contacts and making comparisons One of the earliest honours accorded Titmuss arrived in 1939, although exactly how this transpired is unclear.The Eugene Field Society, based in St Louis, Missouri, informed him that he had been made an honorary member.The society was organised by the National Association of Authors and Journalists, and honorary membership conferred in recognition of the recipient’s ‘outstanding contribution to contemporary literature’. Titmuss thus found himself in the company of figures such as the American poet Robert Frost and the English writer Walter de la Mare.1 Clearly,Titmuss’s writings were already reaching an audience beyond Britain. Shortly after taking up his LSE post, Titmuss advised

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Barbara Wootton on how to handle ‘your argumentative American audiences’ when discussing the still young NHS. Doctors could now, and for the first time, ‘practise good medicine’. Economic and competitive pressures to prescribe had ‘been vastly reduced by the introduction of the National Health Service’, although results would take time, and probably a ‘new generation of doctors’, to materialise.2 This anticipated some of the issues Titmuss was to address when engaging directly with American readers and listeners. Titmuss’s growing reputation as an authority on social welfare caught the attention of Americans engaging with similar issues. In autumn 1951, he was contacted by a University of Birmingham colleague about a Fulbright Scholar presently attached to his department, Arthur Fink. Fink was Dean of Social Work at the University of North Carolina and anxious to meet with Titmuss, ‘as he is specialising on an enquiry into the national health scheme’.3 A meeting duly took place, as Fink recalled a few years later, at which they discussed Titmuss’s ‘study of medical practice in Britain’. Fink sought further information on this research, not least because several members of his university’s Medical School were ‘working on somewhat the same kind of problem with physicians’ in North Carolina. Fink himself was particularly interested in comparisons between Titmuss’s findings on the NHS, and ‘what we are finding here in the private practice of medicine by our physicians in a predominantly rural area’.4 A sociologist based at Purdue University, meanwhile, told Titmuss that she had read ‘with greatest interest your excellent article on “Social Administration in a Changing Society” ’, and considered it ‘one of the best, if not the best, article on the subject I have read for a long time’.5 A particularly noteworthy correspondence was that between Titmuss and Edwin Witte, Professor of Economics at the University of Wisconsin. Witte had been involved in President Roosevelt’s pre-​ Second World War ‘New Deal’. Under Roosevelt, American welfare provision had expanded considerably, and it continued to be an inspiration to those on the liberal left. One of Witte’s protégés was Wilbur Cohen, a key figure in President Johnson’s ‘War on Poverty’ in the 1960s, and whom we shall repeatedly encounter. In 1954 Witte told Titmuss that he had ‘profited greatly’ from their discussion during a recent London visit. Witte thanked Titmuss, too, for alerting him to his recent articles on pensions in The Times, discussed in Chapter 13. Witte was grateful for the meeting, as ‘I knew of your writings in the social security field, but personal contact made your ideas clearer to me than the mere reading of your articles’.6 Two years later Witte was again in touch, this time thanking Titmuss for sending a copy of ‘The

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Social Division of Welfare’.This was an ‘excellent presentation of basic aspects of social welfare services and their place in present-​day Britain’, and Titmuss had examined an aspect of welfare provision ‘no one else has developed.Yet it seems to me important for a true understanding of social security and social services in meeting the outcry against the welfare state’. This outcry was even greater in the US than in Britain, and that ‘Uncle Sam really pays a large part of our industrial benefits’ was a point which he himself had raised on a number of occasions. But it was not generally recognised. Titmuss’s lecture was, therefore, ammunition which he, Witte, could use for his own purposes. Witte concluded by acknowledging Titmuss’s request for material on American industrial (that is, occupational) pensions, and that he was including a list of recent literature about a topic on which there had been ‘a veritable deluge of books and articles’.7 One of Titmuss’s first scholarly critiques of US welfare came in a 1952 article.The NHS had removed economic barriers to health and, to some degree, promoted preventive medicine. But there was now a widespread impression that too much was being spent on health services, and that the way in which they were organised had led ‘to excessive expenditure, over-​consumption of medical care, and inordinate drug-​taking’. The NHS thus stood at ‘a critical point in its history’.The broader context is crucial for, as we saw when discussing the Guillebaud Committee, at precisely this time some Conservatives were arguing that NHS costs were unsustainable, and that funding by insurance should be introduced. Titmuss, however, argued that the need for more knowledge of the service’s operation was ‘obvious to anyone’ confronted by questions from ‘overseas visitors to our universities and medical schools’. It was also the case that an understanding of the problems engendered by increasing demands on medical care could be deepened by ‘the method of comparative studies applied to societies where the psychology of pain and the fear of death resemble attitudes in this country’.8 Accordingly,Titmuss then focused on a study conducted in California. This had taken a sample of middle income families, urban and overwhelmingly white, and assessed their healthcare expenditure.Among its findings was that one quarter were ‘crippled during the year by medical and dental bills, even though not a single case was reported of poliomyelitis or serious psychotic disturbance’. The evidence showed ‘the extent to which some families are utterly broken (in economic terms) by serious illnesses’, with large families suffering most. Even those in voluntary health insurance schemes were not immune from hardship, with the study demonstrating that ‘membership of a prepayment plan

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was often of little benefit’. Consequently, serious illness could ‘spell disaster for all but a small proportion of the population’, and in its ‘dimensions and … social consequences [this was] now, for the United States as for other countries, a national problem –​a problem in social organisation by the whole community’. Rising costs, the expanding volume of medical care, and an ageing population all placed strains on healthcare, and throughout ‘Western civilisation these costs have become far higher during the past twenty years in relation to general price levels and standards of living’. Medicine was thus ‘in danger of pricing itself out of the market place’. As to the NHS, for Titmuss all this showed that expenditure could not be attributed merely to that institution’s existence. Whatever its faults, moreover, the service must have ‘prevented many social disasters from serious illnesses among families at almost all income levels’. It had, in this respect, promoted preventive medicine ‘whose social benefits are unlikely to be fully reaped for a long time to come’. And preventive medicine embraced many other issues including, and here Titmuss quoted Jerry Morris, ‘the way we live together in society’.9 This was far from the last time that Titmuss commented on British and American healthcare by comparing the two systems. And his article was noticed in the USA itself, with requests for offprints from, for example, members of the Schools of Public Health at the Universities of California and Michigan.10

Invitations By the mid-​1950s, Titmuss was beginning to receive invitations to visit the US. In spring 1954 he was contacted by Milton Chernin, Dean of the School of Social Welfare at the University of California. Chernin was in the process of building his School into one of the most important institutions of its type. He first thanked Titmuss for supplying a reference for Lydia Rapoport, a Fulbright Scholar in the latter’s department who went on to be one of America’s leading psychiatric social workers. Chernin continued that his own department had been, over recent years, considering funding a visiting scholar. In the event of the university making resources available, he and his colleagues had ‘always thought that … you would be the very man we would like to invite to join us for a semester’.11 Would Titmuss be interested? Titmuss responded that although he had recently received offers from the US, he had had to turn these down. But a ‘visit to your School would, however, attract me very much and you may take it that I should make every effort to disentangle myself from my duties here should the opportunity occur’.12 No doubt the social workers’

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dispute was one of these ‘duties’, and nothing came of this invitation, at least immediately. Nonetheless, the ball was now rolling. In early 1956 Titmuss received another invitation, this time from Yale. Eugene Rostow, Dean of the Law School, told him he was ‘delighted to invite you … to come to the Yale Law School for a week or so some time during the next two academic years’. As well as public lectures, Titmuss would be asked to ‘meet informally with classes, seminars, students and faculty’.A suitable honorarium would be paid. Rostow suggested that Titmuss ‘take this occasion … for a thoughtful review of British experience with the whole problem of medical care’.This was ‘one the great problems now facing the United States, and your testimony could have far-​reaching effects on American thinking’.13 We see here the concern of American liberals over healthcare, the sense that America could learn from British experience, and that Titmuss was well enough known to have an impact on US policy. Titmuss duly sought the LSE’s permission to be absent for the first three weeks of summer term 1957, so bringing the total length of his stay to around six weeks. He noted, too, that he had also received an invitation from Columbia University in New York. Sydney Caine agreed, and was ‘very pleased that you have received this invitation from Yale University, and also from Columbia. It is an obvious compliment, and I am very glad that you feel able to accept’.14 TheYale invitation prompted a further American response.This came from Eveline Burns, an old friend of Titmuss’s. She too was a New Deal veteran, having worked on the 1935 Social Security Act while still a British citizen, and was one of Titmuss’s key contacts in the US. Burns was a graduate of and had taught at the LSE, and she was to be made an honorary fellow in 1964. She was a key figure in the development of Social Policy as an academic field in the United States, and was a member of staff, and ultimately professor, in the School of Social Work at Columbia.15 Clearly in response to a letter from Titmuss, Burns told him that she was ‘both delighted and chagrined that Yale has invited you to give these lectures’. She was ‘delighted’ because ‘these will bring you over here’, ‘chagrined’ because she had not, as yet, managed to arrange anything similar. She was, though, working on it. In the meantime, she told Titmuss that she knew Rostow personally, and that he was ‘a brilliant chap, a real liberal and … generally very well thought of, at least by the people I know’. His brother was the ‘brilliant’ W.W. Rostow of the Massachusetts Institute of Technology.16 Both Rostow brothers were to serve in President Johnson’s administration in the 1960s, although, as we saw in Chapter 16, W.W. Rostow’s ideas were probably not to Titmuss’s taste, his brilliance notwithstanding.

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Burns was highly active in promoting Titmuss in the US. In August 1956, she told him that she had been ‘spreading the good news of your presence in this country’, and she expected several people would have been in touch. ‘I hope you don’t mind’, she continued, ‘that I have constituted myself as your business manager … in that I have made it very plain to all the people I have contacted that in my opinion they should expect to pay you a fee and expenses’.17 A  few weeks later Burns reported that a formal invitation to visit Columbia was imminent. She had, moreover, recently been at the federal government’s Social Security Administration offices, where ‘all the senior people were delighted to know that you are going to be in the country and expressed the keenest desire for you to spend some time in Washington’. An arrangement would be made ‘whereby you would be officially a consultant for a period of a week’. This would not involve any very formal commitments, aside from an address to ‘the whole group on some subject of your own choice’. Otherwise, Titmuss should simply make himself available for discussions. Burns urged him ‘to consider this possibility for I think you would find it very valuable to meet with the top social security people’, notwithstanding the likely low level of remuneration.18 On the same day, a further letter was dispatched from Columbia.This was from Kenneth Johnson, Dean of Social Work, who was ‘delighted to learn from Eve Burns that you are willing to cooperate with us in our plans for a Conference on Social Policy and that you will be able to give some time at the School either before or after the Conference itself ’. This was, therefore, a formal invitation ‘to plan on giving us three weeks of your time next spring after you have completed your commitments at Yale. I understand that you would be able to join us on April 14th and for our part we are very happy to offer you an honorarium of $500.00 a week’.19 Burns’s contacts in the federal bureaucracy also bore fruit. Shortly before his departure,Titmuss wrote to Charles Schottland, the Federal Commissioner for Social Security, offering a range of potential topics for discussion with the latter’s staff, including the American experience of old age pensions (Titmuss noted that he was presently working on British pension schemes), trends in the development of ‘fringe benefits’ for pensions and medical care, and the cost and quality of medical care.20 The Commissioner of Labor Statistics at the Department of Labor, meanwhile, told Titmuss that he would welcome a meeting when he was in Washington.21 And Canada was not to be left out. Shortly after the Columbia invitation, Titmuss was contacted by the Director of the School of Social Work at the University of Toronto, Charles Hendry. Hendry reminded Titmuss of the invitation he had

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extended the previous year, an invitation reinforced by Professor John Morgan, another longstanding correspondent of Titmuss, at the social work conference in Munich earlier in 1956. After discussions with colleagues responsible for theVera Moberly Lectureship, named after the nurse and social worker who had been instrumental in promoting child protection in Toronto, Hendry could now offer Titmuss this position, which was designed to ‘provide from time to time a lecturer qualified to speak on some aspects of social work in relation to nursing, hygiene, and medicine with special reference wherever possible to child welfare’. A stipend of $250, which included travel expenses from New York to Toronto, was offered, and a possible lecture topic might be infant and maternal mortality under the NHS. He and his colleagues had, for a long time, ‘wanted to have you with us here in Toronto, even for a few days’. The lectureship provided a suitable platform ‘for what we hope will be a thoroughly stimulating and satisfying visit’. In addition to a formal address, it was hoped that ‘opportunity might be provided for a considerable exchange of views between members of our teaching staff and yourself ’.22

Yale and the National Health Service Titmuss, along with Kay and Ann, made his first American visit in 1957, travelling out on the liner Queen Elizabeth (they returned on the Île de France). Among Oakley’s memories of the trip are travelling, by train, to Toronto, and seeing Niagara Falls on the way. She also recalls a barbecue held by Burns and her husband for the Titmuss family, and the vagaries of the couple’s cat. But Titmuss himself was there to do more than sample the joys of American cooking, and Oakley further records that the visit involved engagements at the universities of Columbia,Yale, Harvard, and Michigan –​a schedule she describes as ‘testing’, presumably both physically and mentally. She notes, too, that Titmuss left England ‘at the height of the awfulness of the LSE Affair’, the dispute over social work training, and that David Donnison had been left with the task of trying to sort this out.23 We now look at some of the meetings, formal and informal, that Titmuss had, and his audiences’ responses. He explored a range of subjects. For instance, he addressed a conference at the University of Michigan on ‘Industrial Change and the Employment of Married Women’.24 But his most important public addresses were the three to the Yale Law Faculty in April 1957, the Sherrill Foundation lectures, which were reproduced, virtually unaltered, in Essays on ‘The ‘Welfare State’. As Titmuss noted in that

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volume’s preface, his lectures dealt with aspects of the NHS and had been submitted as evidence, along with other material, to the Royal Commission on Doctors’ and Dentists’ Remuneration (the Pilkington Committee). Titmuss also pointed to the ‘Appendix to Lectures on the National Health Service in England’, likewise reproduced in the volume. In public lectures, ‘one has to deal heavily in generalities’. But such were the ‘many misconceptions’ about the NHS, in both the US and Britain, that he felt, in preparing his talks, that ‘something more than general statements would be appreciated’. Therefore the appendix had been circulated in advance.The lectures themselves were ‘addressed to an American audience’, although it was to be hoped that they contained material ‘of interest to students of the subject in Britain and other countries’.25 All three had the generic title ‘The National Health Service in England’, with the respective subtitles ‘Some Aspects of Structure’,‘Some Facts about General Practice’, and ‘Science and the Sociology of Medical Care’. We briefly examine each of these to see how Titmuss set about dispelling some of the ‘many misconceptions’ about the NHS. ‘Some Aspects of Structure’ was, primarily, an account of how the NHS had been created, what it had replaced, and how it was organised. Presumably much of this was unknown to his American listeners, so providing a contextual framework for lectures two and three.Titmuss, somewhat disingenuously, claimed not to know much about the organisation of American healthcare. But he noted, nonetheless, the professional power of the American Medical Association (AMA), the ‘power ascribed by society as a whole to those who are regarded as professional experts in matters of health and disease’. Aware of the AMA’s consistent opposition to socialised medicine, and its (negative) interest in the NHS, Titmuss’s comment that ‘each distinctive culture gets the medical priesthood it wants’ has a sharp edge. The NHS had been of ‘social value’ to ‘patients and doctors alike’, while in terms of monetary value he gave a summary of his, and Abel-​Smith’s, recent work for Guillebaud.The Committee had been set up at a time when ‘a powerful body of opinion’ in Britain ‘held the view that [the NHS] was failing’, with ‘powerful sections of medical and lay opinion’ claiming that ‘the costs of “socialized medicine” were bound to be astronomical’.When combined with the inadequacy of official statistics, this had led to a situation where ‘for nearly seven years public opinion both in England and the United States has been seriously misled’ about service costs. Among the other aspects of Titmuss’s talk was the current situation regarding NHS charges, where he sought to challenge the notion that its services were entirely free at the point of demand. One

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crucial, if easily missed, point concerned patients’ rights. An ‘essential element’ of the ‘principle of free access to medical care’ was ‘freedom to use or not use the Service and to choose and change one’s doctor’. Nobody was compelled to use the service. A range of options were available so that, for example, a patient might choose to pay their GP, while accessing hospital services without charge.26 Titmuss’s second lecture,‘Some Facts about General Practice’, started by noting the ‘far-​reaching’ effects of the Second World War on British society, the ‘scientific revolution’ in medicine which had begun in the late 1930s, and the ‘immense pent-​up demand for treatment’, coupled with the sacrifices of the decade ending in 1948, which had surrounded the newly founded NHS. Those with ‘little sense of history’ had twisted this overwhelming demand to suggest service failures, and this had given it a bad name. Spokesmen for the BMA, and the AMA, had thus ‘found it all too easy to indulge their fantasies’. Any interest group ‘responsive to the lowest common denominators among its members and well provided with funds’ was well placed to exploit a situation of high initial demand for healthcare, the history of which ‘will one day be worth recording. And on both sides of the Atlantic’. All this raised questions about the role of medicine, and the medical profession, in modern society.Titmuss then focused on general practice, where the NHS had begun to establish ‘a social framework in which the great majority of general practitioners, gradually assimilating the benefits of scientific medicine, may find a more assured and satisfying role than was their lot before 1948’. Nonetheless, in a rapidly changing society, there remained issues to be addressed, including ‘the reform of medical education’, another familiar theme. The methods of GP remuneration were outlined, conflict with hospital consultants in this area acknowledged, and it was noted, too, what an attractive profession medicine was for its middle class practitioners, with the state subsidising the bulk of medical training.27 Titmuss then moved on to what may have been the most compelling section of this talk for an American audience, professional freedom. Many doctors had feared the coming of the NHS, and that, for example, its method of remuneration would threaten clinical freedom. But this ‘fear … has not materialized’. Similarly, concerns over job security had been misplaced, as had those about interference in clinical decisions by administrators. In reality, the NHS allowed doctors the ‘freedom to serve … patients according to their medical needs’.This was especially true for sections of the population such as women and the chronically ill. Although Titmuss did not spell this out, such groups had often been disadvantaged prior to 1948. Now, though, doctors did not have

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to consider patients’ financial circumstances, of itself an important medical advance. For GPs, in the ‘last ten or fifteen years the potential sphere of work’ had been extended.They could, for instance, now treat many conditions previously requiring hospitalisation. So the NHS had not deprived GPs of their ‘family doctor’ role. On the contrary, it had become ‘more possible for more general practitioners to function as family doctors’. And fears that the service’s introduction would lead to a permanent increase in demand for medical services (by which he meant, essentially, increasing doctors’ workloads) had been shown to be unjustified. Indeed, albeit on the basis of limited data, ‘on average and contrary to public belief, demand has not increased … and may have indeed fallen’. Finally, what about the quality of care provided by GPs under the NHS? This was difficult to measure, but it was almost certain that current arrangements were, for most patients, an improvement on what had gone before. And that general practitioners had the opportunity to spend more time with their patients could only be to the good. No longer, then, could the family doctor be ‘dismissed as a specialist in the trivial’.28 Titmuss’s third address,‘Science and the Sociology of Medical Care’, immediately picked up the point about GP status. For some time before the advent of the NHS, the general practitioner had been ‘socially and professionally isolated from the broad stream of developments in medicine, public health and social welfare’. Education for general practice had been neglected, consultants had assumed the GP to be ‘something of a mediocrity’, and practitioners were, for the most part, a ‘single-​handed, professionally isolated, private-​entrepreneur’ leading an ‘often unsatisfying professional life’. As he had already argued, the NHS’s introduction had begun changing attitudes, although much remained to be done, while old perceptions died hard. Underlying ongoing problems for GPs were two intimately related phenomena, ‘the penetration of science into medicine and the growing division of labour within medicine itself ’. As an instance of the former, the ‘detection of disease processes, now of strikingly greater importance in general practice’, had greatly benefited from advances in organic chemistry. The pace of change was also notable, for example in the recent discovery ‘of a whole new series of valuable antibiotics’. But advances in medicine raised questions about the doctor’s ‘social role’, and this led into an analysis of the medical division of labour and its impact on, most notably, the doctor/​patient relationship. One consequence of increasingly scientific medicine was professional specialisation. This was ‘based on a scientific rationale instead of as in the past an accumulation of empirical evidence by the individual practitioner’.

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Since 1948 there had been ‘an internal professional struggle for status’, resulting in the ‘social differences’ between specialists widening,‘while the gulf between the general practitioner and specialists as a body has widened further’. This was the context in which ‘recent controversies about medical remuneration’ had to be placed, including a very public dispute between GPs and consultants.29 One outcome of all this was the ‘increasing fragmentation in responsibility for the treatment of the individual patient’, with the emphasis shifting from the ‘person to some aspect of his disease’. But while science was pushing medicine towards professional specialisation, it was also pulling it towards greater cooperation and group practice, ‘more team reliance on special skills and functions’. Many of the present tensions in the NHS, then, were due not to its organisational structures, although many doctors believed they were, but to these contradictory forces. Again focusing on GPs, it was in this context that ‘we can trace the steadily rising tide of complaints from general practitioners about their loss of status and their sense of insecurity’.Various obstacles faced GPs in a period of rapid change. These included medical education, for the training which most GPs had received did little to help them ‘adjust to change’. Such training was based primarily around hospital medicine, ‘a very different experience from the average work of the average general practice’. Finally,Titmuss turned to the doctor/​patient relationship, pointing out that clinicians were now faced with a ‘more knowledgeable and articulate body of patients’, especially when the latter came from the professional and middle classes. This put further pressure on doctors, to which they might respond in various ways, for example by adopting an ‘authoritarian role in the giving and withholding of drugs’.30 The notion of the ‘authoritarian’ doctor clearly exercised Titmuss. Scientific medicine had certainly undermined many of the ‘personal, individual authoritarianisms in medicine’. Clinical medicine now had, by contrast, a ‘new spirit of criticism and questioning’, had rejected certain traditional, individualistic, techniques, and given doctors greater scope for independent thought and action, while making them more dependent on other professionals. However, there was potential for a new form of authoritarianism. Scientific medicine and specialisation brought with them the possibility of more complex and rigid hierarchies, and sets of rules governing them. There were, consequently, ‘dangers’ for both patients and doctors  –​of medicine becoming a technology, of a new authoritarianism leading to ‘professional syndicalism’, and of the power of medicine within society as a whole, ‘a problem which concerns much more of our national life than simply

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the organization of medical care’.The NHS’s very existence had helped highlight such issues, and while there were no easy solutions, society’s challenge was to make ‘medicine more “social” in its application without losing in the process the benefits of science and specialized knowledge’. Indeed, the ‘fundamental justification’ for the NHS was the ‘framework through which medicine may more nearly fulfil its honoured promise’, and ‘the means by which the freedom of patient and doctor alike may be enlarged’.31 Titmuss’s Yale lectures, important as they were for his standing in America, did not say anything especially new, at least as far as fellow Britons might have been concerned. Nonetheless, in certain themes he picked up, it was undoubtedly significant that he was addressing an American audience. This helps explain, for example, his particular engagement with professional freedom, for it was especially around this issue that bodies such as the AMA perceived a ‘threat’ from socialised medicine, namely that doctors would be subordinated, organisationally and clinically, to bureaucrats and politicians.This was an argument which the BMA had been happy to employ in the 1930s and 1940s. All this prefigured the debates, discussed in Chapter 23, over President Johnson’s modest attempts to expand American health insurance. More broadly, Titmuss’s concern for individual choice, on the part of both patients and doctors, illustrates his concern for individual freedom in modern societies, especially in the light of what he saw as their dangerous drift towards social conformity.

Columbia and social work Another important component of Titmuss’s 1957 trip was his engagement with the Columbia School of Social Work.This occurred both at the School itself, and at a conference held at Arden House, a building in upstate New York gifted by the Harriman family a few years earlier. Kenneth Johnson told his students that the School was ‘honored’ by the visit of such a distinguished scholar, and that there would be a meeting on 30 April to which all students were ‘invited and urged to attend’. Indeed, this was ‘an occasion of such importance’ that classes were being cancelled at the time scheduled for the meeting, and, where possible, students on fieldwork assignments would be excused for that afternoon. A reception would follow, ‘at which I hope as many of you as possible will be able to meet Professor Titmuss personally’.32 Johnson also wrote to his staff. Titmuss would be visiting the School after the Arden House conference, and the meeting with students would go under the title ‘The Social Worker in a Social Welfare State’. He would

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also attend meetings of the School’s Committee on Curriculum in Social Policy. Johnson appended the minutes of a previous meeting of this body. These contained a list of questions which it had drawn up to put to Titmuss, these being, ‘In what areas of social policy responsibility do social workers at various levels function in Britain?’, ‘Where do they get their training?’, and ‘How does Professor Titmuss teach social policy in his courses?’33 Johnson did not stop there. In a press release for the Arden House Conference on Social Policy, he remarked that Titmuss would be one of the ‘notable educators and administrators’ in attendance.34 Johnson also reported on discussions Titmuss appears to have led at the School prior to the Arden House meeting. Their subject matter, generically ‘the main pressing problems of modern industrialized society’, included the employment of married women, and old age and social security. But it was how Titmuss was described in the press release, and its attached documents, which is most striking. He was ‘Britain’s outstanding authority on social policy’, and, as such, ‘world-​famous’. More than this, In Great Britain, where the social sciences have always ranked at the top of the intellectual hierarchy, Richard M. Titmuss speaks with more authority than any other individual about social policy and social welfare. His is Britain’s most respected voice on matters ranging from the British Health Service to child health and welfare, industrialization, old age, pensions, health and unemployment insurance, and the social development of the nation.35

Even allowing for the hyperbole associated with press releases, this was a bit much.Titmuss may well have been Britain’s leading authority on social policy, but by the same token he was at this stage one of the few, at least in academic life, who took such matters seriously. It was, after all, Titmuss’s ambition to create an academic field, and while by 1957 an impressive start had been made, he would probably have acknowledged that there was still some way to go. His international reputation was certainly growing, but ‘world famous’ was stretching it. And the idea that social sciences were then (or, indeed, now) ‘ranked at the top of the intellectual hierarchy’ is, to say the least, debatable. Certainly, the LSE was blazing a trail, but the expansion of social sciences in Britain did not come until the 1960s, and even then some institutions held out, the University of Cambridge’s half-​hearted, and unsuccessful, attempt to poach Titmuss being a case in point. Such overblown rhetoric does, though, tell us something about how Titmuss was perceived in America.

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A sense of what Titmuss had to say can be gained from a newspaper report of the Arden House meeting, which was under the direction of Burns.Although purportedly about social policy, it was more about the need for social workers to engage with social policy issues, and for this to be reflected in their training. In his keynote address,Titmuss lamented social workers’ failure to take the lead in their own profession’s education, something he attributed partly to their failure to take an interest in social policy. Consequently, it was other professions, for example sociologists and economists, who had taken the key academic posts in the field of Social Administration. Here Titmuss was almost certainly thinking of, on the one hand, his current troubles over social work training at the LSE, and, on the other, appointments to his department such as Abel-​Smith, trained as an economist. But it also ties in with his argument, encountered previously, that social workers should engage with other social scientists. In ‘an era of unprecedented public interest in social policy problems –​Social Security, old age, housing, physical and mental health –​social work continues to occupy a subordinate place in the academic world’. That this was not a problem confined to Britain was borne out by the response to his speech, with Burns claiming that the modern social worker was buried in ‘casework, paper work and in “specialities” such as psychiatric social work rather than in meeting problems of social policy or seeking leadership in the field’.36 It is easy to see why Burns and Titmuss got along. Interventions such as these were important, clearly struck a chord with receptive American audiences, consolidated the links between Titmuss and American colleagues, and laid the foundations for the transatlantic networks in which he played a leading role. Titmuss’s 1957 visit certainly evoked some positive responses. Kenneth Johnson, not one to understate matters, assured Titmuss –​‘my friend’ –​ that he had made ‘a tremendous contribution to the New York School and to social work in the USA’. Johnson assumed that Burns would have passed on ‘the many favourable comments’ received from Arden House participants. There had, too, been a strong demand for copies of the papers presented, and ‘particularly yours’. Johnson concluded that much ‘good will come of all you did for us –​of that I am sure’. He and his wife had ‘enjoyed meeting and knowing you, your lovely lady and Ann (alias “My Fair Lady”)’.37 Flattering as it perhaps was to be compared to Julie Andrews, the story which unfolds in ‘My Fair Lady’ might have been less acceptable to the future Professor Oakley. Others, too, wrote in terms that seem more than simple politeness. Reflecting on a meeting between Titmuss and federal employees,Agnes Brewster, a medical economist at the Social Security Administration,

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told him that ‘As we knew it would be, your visit to Washington was one of the brightest spots of the spring’. She could not recall any previous occasions after which ‘so many expressions of appreciation have been voiced’. Brewster had hosted an event in her home for the Titmuss family, and enclosed a list of attendees.38 Robert Ball, later to be Social Security Commissioner under Presidents Kennedy, Johnson, and Nixon, thanked Titmuss for the time given to staff at another part of the Social Security Administration, the Bureau of Old Age and Survivors Insurance. The group had ‘learned much from you in the short time we had and know that we would have profited even more could the time have been longer’. Ball was clearly flattered, too, that Titmuss had mentioned a report of his own when talking to Bureau employees, and Titmuss’s claim that his own thinking had been influenced by Ball’s work.39 In fact, by the time Ball wrote, the director of the Bureau, Victor Christgau, had already contacted Titmuss, and he too expressed his thanks for ‘your willingness to come to Baltimore and address our staff ’. Christgau had found Titmuss’s talk ‘extremely stimulating and from the numerous comments I have heard I know that you were well received by all who were there’. The smaller meetings which had also taken place ‘were very informative and helpful too, particularly to our program planners’.40 Social Security officials continued to seek Titmuss’s advice after his return to the UK. In the summer of 1959, for example, a deputy commissioner, George Wyman, sent him a copy of a paper by Alvin Schorr, ‘Problems in the Aid to Dependent Children Program’, asking for his comments. Titmuss claimed not to be up to date about this programme’s workings, but understood its basic principles. However, he had liked Schorr’s piece for the ‘clarity with which it disentangles some of the fundamental moral and policy decisions in this area’. Britain’s national assistance scheme, he noted, had similar problems to those experienced by Aid to Dependent Children.41 Schorr was to become a friend, as well as an admirer, of Titmuss, and we shall meet him again on various occasions.

Conclusion Titmuss’s first American visit must be counted a success, and he was to build on the contacts established over the coming decade and a half. His cooperation with Odin Anderson shortly afterwards, discussed in the next chapter, is further evidence of his growing reputation in the US. But clearly Titmuss was already well known there before he set foot on the Queen Elizabeth. The trip had been actively encouraged,

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and welcomed, by senior academics and by senior welfare officials, he addressed leading academic institutions and federal agencies, and was even involved in curriculum development at Columbia in his capacity as an authority on welfare matters. Although he clearly had personal contacts among Americans interested in social policy, much of this initial interest could only have come from his writings. Notes 1 TITMUSS/​7/​47, letter, 3 July 1939, Eugene Field Society to RMT. 2 TITMUSS/​2/​124, letter, 17 November 1950, RMT to Wootton. 3 TITMUSS/​7/​59, letter, 22 October 1951, P.  Sargant Florence, Faculty of Commerce and Social Science, to RMT. 4 TITMUSS/​7/​62, letter, 25 May, 1954, Fink to RMT. 5 TITMUSS/​7/​61, letter, 19 May 1953, Hanna H. Meissner to RMT. 6 TITMUSS/​7/​62, letter, 26 July 1954, Witte to RMT. 7 TITMUSS/​7/​64, letter, 5 April 1956, Witte to RMT. 8 R.M.Titmuss,‘The Cost of Medical Care: American Experience and the NHS’, Lancet, I, 1952, p 605. 9 Ibid, pp 605–​6. 10 TITMUSS/​7/​60, letter, 13 May 1952, Fern E.  Scneder, Associate in Public Health, School of Public Health, University of California (Berkeley) to RMT; and TITMUSS/​7/​61, letter, 1 May 1953, S.J.Axelrod,Associate Professor of Public Health, School of Public Health, University of Michigan. 11 TITMUSS/​7/​62, letter, 24 May 1954, Chernin to RMT. 12 TITMUSS/​7/​62, letter, 1 June 1954, RMT to Chernin. 13 TITMUSS/​7/​64, letter, 15 May 1956, Rostow to RMT. 14 LSE/​Staff File/​Titmuss, letter, 18 June 1956, RMT to Caine; and letter, 19 June 1956, Caine to Titmuss. 15 For her career and significance, V.  Shalakman, ‘Eveline M.  Burns:  Social Economist’, in S. Jenkins (ed), Social Security in International Perspective: Essays in Honor of Eveline M. Burns, New York, Columbia University Press, 1969, pp 3–​25. 16 TITMUSS/​7/​64, letter, 28 May 1956, Burns to RMT. 17 TITMUSS/​7/​64, letter, 31st August 1956, Burns to RMT. 18 TITMUSS/​7/​64, letter, 2 October 1956, Burns to RMT. 19 TITMUSS/​7/​64, letter, 2 October 1956, Johnson to RMT. 20 TITMUSS/​7/​65, letter, 13 March 1957, RMT to Schottland. 21 TITMUSS/​7/​65, letter, Ewan Clague, Commissioner of Labor Statistics, Department of Labor, Washington. 22 TITMUSS/​7/​64, letter, 27 November 1956, Hendry to RMT. 23 Oakley, Father and Daughter, pp 140–​4. 24 TITMUSS/​7/​65, flyer University of Michigan, programme for a conference to be held on 12 April 1957 at Ann Arbor. 25 R.M. Titmuss, ‘Preface’, in Essays on ‘The Welfare State’. 26 R.M. Titmuss, ‘The National Health Service in England:  Some Aspects of Structure’, in Essays on ‘The Welfare State’, pp 135, 134–​6, 147ff, 148, 149–​50, 138–​9. 27 R.M. Titmuss, ‘The National Health Service in England:  Some Facts about General Practice’, in Essays on ‘The Welfare State’, pp 152–​4, 155, 159, 161ff. 28 Ibid, pp 165ff, 169–​70, 171, 173, 174, 176–​7.

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Titmuss and North America: early encounters and first visit 29 R.M. Titmuss, ‘The National Health Service in England:  Science and the Sociology of Medical Care’, in Essays on ‘The Welfare State’, pp 178–​9, 180, 185, 186, 188, 189–​90. 30 Ibid, pp 190, 193, 196–​7, 200. 31 Ibid, pp 200–​201, 201, 202. 32 TITMUSS/​7/​65, Memorandum, 10 April 1957, Johnson to Members of the Student Body. 33 TITMUSS/​7/​65, Memorandum, 10 April 1957, Johnson to Faculty. 34 TITMUSS/​7/​65, Press Release, 16 April 1957, ‘Major conference on Social Policy will be held at Arden House next week, Dean Johnson of the New York School of Social Work announces’. 35 TITMUSS/​7/​65, Press Release, 16 April 1957,‘Employment of married women, changes in family life, old age and social security are called the main pressing questions of modern industrialized society: Britain’s outstanding authority on social policy, Professor Richard M.  Titmuss, lists problems at the New  York School of Social Work of Columbia University’, plus two attached documents. 36 E. Harrison, ‘Leadership Lack in Welfare Cited’, The New York Times, 24 April 1957, p 23. 37 TITMUSS/​7/​65, letter, 25 June 1957, Johnson to RMT. 38 TITMUSS/​7/​65, letter, 5 June 1957, Brewster to RMT. 39 TITMUSS/​7/​65, letter, 22 May 1957, Ball to RMT. 40 TITMUSS/​7/​65, letter, 17 May 1957 Christgau to RMT. 41 TITMUSS/​7/​67, letter, 18 June 1959, RMT to Wyman.

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22 Helping American scholars on British topics Introduction Titmuss, despite his ever mounting commitments, was generous with his time, and this applied to other academics, both junior and well established. This chapter examines his support for American scholars working on British subjects.This could take the form of, for example, advice on sources, supplying suitable contacts, reading manuscripts, or facilitating a collaborative project. A  number of the individuals involved were visitors to the LSE and, on occasion, Titmuss’s home, and all went on to, or were already pursuing, distinguished academic careers in the US. While Titmuss undoubtedly gave his support for unselfish reasons, nonetheless the establishment of further contacts in American academia can only have added to his transatlantic networks. It is not suggested that the individuals discussed below were the only American scholars Titmuss aided. Rather, each illustrates the generosity of Titmuss’s collegial approach to academic life, and the perception of him as an authority on social welfare. It is the case, too, that these Titmuss-​inspired, or aided, works can be viewed as commentaries on American social policy, something with which Titmuss himself was intimately engaged, and the subject of the next chapter. Equally, some of Titmuss’s comments further illuminate his perceptions of contemporary British society.

Social welfare: Heclo and Gilbert We have already encountered our first recipient of Titmuss’s support, Hugh Heclo, later Professor of Government at Harvard University, who had worked for Titmuss during the latter’s membership of the Finer

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Committee. Titmuss had been instrumental in Heclo’s appointment, and was clearly keen to promote the young American’s career. Heclo dedicated his first major academic work, Modern Social Policies in Britain and Sweden, which came out shortly after Titmuss’s death, to him and Kay. Below the dedication are the lines ‘we learned that in quiet places reason abounds, that in quiet people there is vision and purpose’.This (unattributed) quote comes from the liberal Democrat, and supporter of progressive causes in America, Adlai Stevenson, and so gives a sense of Heclo’s own political position, as well reflecting his feelings about Titmuss and Kay. It also adds to the picture of Titmuss and his wife as serious, but modest, individuals. Heclo’s book drew extensively on his British and Swedish research, part of which had also contributed to Finer, and as we have seen remains an important source for the deliberations of the Labour Party, and Titmuss, over pensions. As previously suggested, the passages on pensions almost certainly benefited from information supplied to Heclo by Titmuss, Abel-​Smith, and Townsend. In the volume’s preface, Heclo singled Titmuss out for special thanks, noting that ‘Above all there is my debt to Richard Titmuss, who taught by example the moral basis of a commitment to welfare’. This, of course, alludes to Titmuss’s recent essay collection, while reminding us of the moral foundations of his work.And of the latter’s publications, Heclo extensively utilised Commitment to Welfare and Problems of Social Policy. He also acknowledged the support of members of Titmuss’s department, for instance Abel-​Smith, Pat Thane, and Jose Harris.1 In her review of Heclo’s book, Harris suggested that, although it had flaws, overall it was a ‘powerful and stimulating work’. She concluded by noting that the volume was dedicated to Titmuss, and was ‘a worthy reflection of Titmuss’s lifelong attempt to balance historical materialism with the study and generation of autonomous political ideas’.2 Heclo himself took a further opportunity to sing Titmuss’s praises in his assessment of the posthumously published Social Policy: An Introduction. In an insightful comment, which strongly hints at Titmuss’s distaste for ‘abstract’ theory, Heclo observed that given the ‘choice between constructing an elegant formalization and a practical-​minded working and reworking of the basic groundwork’,Titmuss invariably chose the latter. He thus paid his subject ‘the compliment of recognizing its complexity and unavoidable dilemmas’. More broadly, central to Titmuss’s work was ‘the firm moral commitment and the equally strong insistence that others should and must choose for themselves’. Titmuss was a ‘man who lived as he believed’, and, although the book was short, ‘both the man and his thought come through. We could not ask for more’.3 Titmuss therefore helped Heclo in practical ways, while his

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character clearly had a strong impact on the younger man. And it is noteworthy that Heclo highlighted, alongside the moral foundations of Titmuss’s work, the latter’s ‘insistence’ on individual choice, further evidence of his commitment to individual freedom. The second scholar in this section to benefit from Titmuss’s advice was Bentley B.  Gilbert, in his mid-​30s and Associate Professor of History at Colorado College at their first encounter. The two met in July 1960, when Gilbert was researching what was to become his pioneering work on the history of British social insurance. Gilbert wrote to Titmuss the next day to let him know he was working on the Beveridge papers, then held in Oxford. Later in the year Gilbert wrote again to wish Titmuss happy Christmas, and to ‘thank you for your courtesy and help last summer. The intrusion into one’s private existence by an unknown American who asks a lot of personal questions is not ordinarily an easy thing to take’.Titmuss had been, Gilbert noted, ‘most kind, and generous with your time’.4 Gilbert’s book on social insurance in the crucial period before the First World War was published in 1966. As we saw in Chapters 12 and 13,Titmuss had written on the same period, and similar subject matter, in an essay published in 1957. In his acknowledgements, Gilbert gave his ‘special thanks’ to Titmuss,‘from whose encouragement this book grew in the first place but who by now may wish he had let well enough alone’.5 Titmuss, in his preface, did not stint his praise, suggesting, first, that ‘British students of social policy will assuredly acknowledge their debt [to Gilbert] after reading this book’. Gilbert’s was the first ‘definitive’ history of social policy formation in the early twentieth century. The measures under examination ‘did not represent, as Professor Gilbert remarks,“a conscious search for a revised philosophy of poverty” ’.This last point,Titmuss claimed, would provide analysts of ‘the contemporary American War on Poverty’ with some ‘analogies if not resemblances’. Titmuss, as we shall see, publicly expressed his scepticism about the fundamental basis of President Johnson’s programme. Concluding, he claimed that nobody who read ‘Professor Gilbert’s absorbing account’ could ‘with honesty continue to subscribe to the myth that lobby pressures do not exist in Britain or are relatively ineffectual in the party political system’. This was an allusion to the hostility of the medical profession, and commercial insurance companies, to early proposals for health insurance in the run-​up to the 1911 National Insurance Act. Titmuss contrasted the ‘commercial insurance lobby’ with the ‘great Friendly Society movement’, that is the voluntarist, mutualist, self-​help bodies set up to provide their members with a measure of social security. Similarly, such readers could not now continue to accept the ‘placid,

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conventional, textbook account of the historical romance of “Welfare Statism” ’.6 Again, we see here Titmuss’s scepticism about professional power, any ‘Whiggish’ interpretation of the history of social policy, alongside his support for certain forms of voluntarism. Gilbert’s book was well received.The notice in Public Administration, for example, remarked on the ‘extraordinary amount of research effort involved’ in the volume’s production, and concluded that it was a work which could be ‘strongly recommended’. The reviewer suggested, too, that Titmuss might well be right in his claims about the work’s originality and significance.7 Gilbert went on to write further works on British history, including a biography of Lloyd George, became a Professor of History at the University of Illinois, and was a key figure in promoting British studies in North America.

Health: Eckstein, Lindsey, and Mencher In this section we look at another three American scholars working on British social policy, in this case primarily the health services. One of the first historical accounts of the NHS, on either side of the Atlantic, was produced in 1958 by Harry Eckstein, a Harvard political scientist. Eckstein was to go on to also write an important account of how the BMA operated, revealingly entitled Pressure Group Politics:  The Case of the British Medical Association.8 The NHS volume, The English Health Service: Its Origins, Structure, and Achievements, which covered the period from the end of the First World War to the mid-​1950s, drew heavily on both the work of Titmuss and Abel-​Smith for Guillebaud, and Problems of Social Policy.Titmuss was acknowledged as having read Eckstein’s manuscript (whether in part or in whole is unclear), and commenting upon it. Eckstein was not uncritical of the NHS, although he attributed many of its problems to, for instance, the buildings and other forms of capital it had inherited, and, very much along the Titmuss and Abel-​Smith line, underinvestment. Indeed in producing his balance sheet of achievements and shortcomings, he made a plea for an NHS ‘spending spree’ in place of a continuance of the ‘miserly penny-​pinching necessary in the immediate post-​war period’. To the argument that ‘the country cannot afford it’ he countered, again in sentiments to which Titmuss would have subscribed, that ‘if a society conscious of its medical needs cannot afford a decent medical system, what can it afford?’9 Eckstein’s book was reviewed by Titmuss’s friend Eveline Burns, who criticised the author, rather unfairly, for not making enough use of the Titmuss and Abel-​Smith material produced for Guillebaud, and

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for what she saw as an over-​emphasis on the NHS’s shortcomings, not least in the light of its relative youth (the NHS was celebrating its tenth anniversary the year Eckstein’s book was published). But she also praised the work for its historical account of British healthcare, and its usefulness, thereby, to the ‘non-​specialized reader who is unfamiliar with the work of Titmuss and other British scholars’. Eckstein was correct, for instance, to point to the ‘chaotic and irrational nature of the organizational arrangements for the provision of medical care’ which preceded the NHS, the poor quality of general practice, and the uneven distribution of doctors and medical services. Burns emphasised, too, the cost barrier to the patient prior to the service’s introduction.10 Another American reviewer was the public health expert and Yale academic Ira Hiscock. There is no direct evidence that Hiscock had attended Titmuss’s Yale lectures, although given their content it is a strong possibility. Hiscock, too, noted certain drawbacks in Eckstein’s book, but also that the work had been scrutinised by Titmuss, and others, in England. Overall, it was ‘especially valuable for the American reader and student of medical care plans’, and as such held ‘useful lessons for the United States’.11 Both Eckstein’s book and the two reviews were, of course, concerned in the first instance with the NHS. But it is difficult not to see them, coming as they did before Kennedy’s election victory and President Johnson’s ‘War on Poverty’, as critiques of medical provision in the US, since many of the criticisms of pre-​NHS British healthcare applied to that of contemporary America. More broadly, Eckstein’s book, published by a prestigious American press and initially aimed at an American audience, was a further means by which Titmuss’s ideas were to be broadcast in the US. Another important American contribution to an understanding of the NHS, in both Britain and the United States, came in 1962 with Almont Lindsey’s Socialized Medicine in England and Wales. Lindsey, a historian at the University of Virginia, contacted Titmuss in early 1960 asking if he would read his manuscript.Titmuss duly did, and was very positive. He urged its publication in the US, where, drawing on his knowledge of American ‘problems’ and his own experiences during his 1957 visit, Titmuss suggested that Lindsey’s book would ‘meet a real need’.The text was as ‘objective as these things can be made; accurate, comprehensive and lucidly written’. It also covered subject matter not included in Eckstein’s work, which was in any event ‘considerably out-​of-​date’. The volume should be published ‘without reference to the British market’, for although an argument could be made for its publication there, the case was not strong. Along with these, mostly encouraging, comments Titmuss appended four pages of notes.12

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Titmuss duly received a small honorarium from Lindsey, who hoped to have the opportunity to meet him at some point in the future, and he thanked Titmuss for the ‘careful consideration which you have given the material which I sent you’.13 Notwithstanding Titmuss’s caution about the issue, Lindsey enquired into UK publication. Titmuss was asked by his own publishers, George Allen and Unwin, whether they should take on the volume. He doubted whether there was a sufficiently large British market, and would not promote its use as a student text. But, more positively, he stressed that it was a ‘solid, factual piece of work with lots of elementary stuff for Americans with wrong-​headed ideas about “socialised medicine” ’.14 In the summer of his book’s publication, Lindsey told Titmuss that it had impressed an official of the National Broadcasting Company, a Mr O.W.Westfield, who was working on a project about the NHS with the ultimate aim of a TV programme. Westfield was soon to visit Britain, and Lindsey had suggested that he contact Titmuss and Abel-​Smith, and would ‘appreciate any guidance you can give him’. Lindsey assured Titmuss that Westfield would ‘give the British Health Service the type of coverage that you will like’. It is not clear what came of this but, once again, it does show contemporary American interest in healthcare reform and what could be learned from Britain, and Titmuss’s standing as an expert on the topic. Lindsey finished off by again expressing his ‘appreciation for the assistance you gave me in the preparation of [his book’s] manuscript.You were a big help’.15 In the book itself, Lindsey suggested his study would give a ‘reasonably unbiased understanding of the British approach to one of the more challenging problems of our age’, an oblique reference to contemporary, but very modest, American proposals for expansion of state-​supported health insurance. He remarked, too, on American hostility to the NHS, and thereby socialised medicine, something that, as we have seen, exercised Titmuss.Titmuss was acknowledged as helping Lindsey with his book, and was cited as an authority on a number of occasions. So, for instance, his and Abel-​Smith’s ‘painstaking research’ for Guillebaud was duly recognised. Their findings had revealed ‘prudence if not frugality’ in health service expenditure. Similarly Titmuss, a ‘careful student of the British Health Program’, had shown that under the NHS hospital staff ‘enjoyed better conditions than had ever existed before’.16 Although scholarly in tone and methods, Lindsey comes across as an admirer of the NHS. This was made especially apparent in a letter to Titmuss in early 1963. Lindsey praised a recent article by Titmuss in the American magazine Harper’s in which he sought to address American

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misconceptions about the NHS, and which he was at pains to defend against critics such as the American Medical Association. This article is discussed more fully in Chapter 27 in the context of Titmuss’s conflict with the IEA. But for present purposes what is important was Lindsey’s wholehearted agreement with Titmuss’s approach, remarking that the latter had ‘said precisely what needs to be said in the United States, and it cannot be said enough’. Lindsey also noted a recent tour of North America by David Stark Murray, a leading member of the Socialist Medical Association in Britain, and an acquaintance of Titmuss’s. Lindsey had heard one of Murray’s lectures which he thought ‘excellent’.Those such as Titmuss and Murray ‘do a lot of good on the subject of the NHS’. Lindsey concluded by remarking that his own book had just been published.17 In reply,Titmuss noted that Lindsey’s ‘valuable book’ was beginning to be reviewed in Britain, and that he himself had done so for the new journal Medical Care.18 Titmuss started his notice, not untypically, by remarking that there was ‘much talk these days about Britain’s changing place in the world’. There might be a decline in ‘national greatness’ if this was defined by, for instance, ‘ownership of an empire and nuclear power’. Given current Cold War tensions, and British decolonisation, this was a pointed remark. But other criteria might suggest different outcomes, for was not ‘the capacity to do admirable things admirably one of the marks of the good society?’ –​echoes of Eckstein, and consistent with Titmuss’s views on the moral purpose of welfare. Titmuss speculated that Lindsey likewise subscribed to such a view. First, though, he noted the assiduous research undertaken for a book which maintained throughout ‘the approach of the cool and balanced historian’. Lindsey appeared to have read everything produced on the NHS since the 1940s, and the bibliography was ‘the best that has so far been published’. The volume had obviously been written for an American audience, and as such there was little new for the ‘British student of the health service’. But even for the latter it would be an ‘excellent source book’. More importantly, and again with an eye on contemporary developments in the US, if ‘the American public can be persuaded to read [Lindsey’s volume] there should be no further misunderstandings about professional freedom in Britain’. Only once had Lindsey dropped his ‘cool and balanced’ approach, in the ‘outburst’ on the final page. Here the author had argued that ‘the Health Service cannot very well be excluded from any list of notable achievements of the twentieth century’, and had become part of the British way of life to the extent that it was ‘difficult for the average Englishman to imagine what it would be like

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without those services that have contributed so much to his physical and mental well-​being’.19 These were sentiments to which Titmuss himself would have subscribed, and the apparent disjuncture between the ‘cool and balanced historian’ and his ‘outburst’ recalls the dual nature of Problems of Social Policy. More immediately, such a positive review from an acknowledged authority on the NHS, both in Britain and in America, surely gave Lindsey’s book a good start in life. Equally, and as with Eckstein, Lindsey was engaging in the first instance with healthcare in Britain, but with an eye on what was happening in his own country, a process in which Titmuss was complicit. It is notable, too, that Titmuss, yet again, specifically alluded to the issue of professional freedom. There was a touching, and revealing, fallout from Titmuss’s approval of Lindsey’s book. In summer 1963 he received a letter from a Los Angeles high school student, Dan Siminoski. Siminoski belonged to his school’s debating society, and was researching the designated subject for the current year, one which again reflects contemporary American political concerns: ‘What shall be the role of the federal government in providing medical care for the citizens of the United States’. Siminoski’s particular task was ‘to find out details of the British social medicine system.Your name has come up during my research’. In response,Titmuss suggested Essays on ‘The Welfare State’, the Harper’s article noted earlier, and Lindsey’s Socialized Medicine in England and Wales.20 This was generous on Titmuss’s part, both in helping the high school student and in boosting Lindsey’s recent book. Siminoski may have found his recommended reading inspiring in that he went on to write a doctoral thesis with the University of Wisconsin’s Institute for Poverty Research on urban planning in Los Angeles. He also became a leading gay rights activist. An early example of Titmuss’s support for American scholars came in 1953–​54 when his department hosted a Fulbright scholar, Sam Mencher, who was undertaking research on the voluntary sector’s role in social welfare. Mencher was to die young, aged 49, in 1967, and the foreword to one of his two posthumously published works, written by Eveline Burns, noted that while Mencher was at the LSE Titmuss had ‘quickly recognized his qualities and arranged for him to deliver a number of lectures, including the distinguished Loch Memorial Lecture’.The book itself, Poor Law to Poverty Program: Economic Security in Britain and the United States, was a historical and comparative study of income maintenance in Britain and the United States, with some of Titmuss’s more recent work approvingly cited.21 The Loch Memorial Lecture, meanwhile, was named after the social reformer and leading

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figure in the Charity Organisation Society (COS –​later Family Welfare Association), C.S. Loch. The series had been set up in his memory by the COS, and over the years was to have contributions from distinguished figures in the field of social policy, for example David Donnison. Mencher spoke on the relationship between the voluntary and state sectors in Britain and, very much following the Titmuss model, was sensitive to historical context. His concluding remarks, too, have a Titmuss ring to them, stressing that while statutory/​voluntary cooperation was of value in itself, nonetheless the ‘values inherent in any mode of co-​operation must be judged in terms of the ultimate ends desired’. In other words, social policy must have moral purpose.22 Jumping forward to Mencher’s death, by which time he was Professor of Social Welfare at the University of Pittsburgh,Titmuss was informed of this by a colleague at the Columbia School of Social Work, Irving Lukoff.The latter noted that Mencher had completed a further manuscript based on recent work, deriving from research carried out in England. Lukoff added, too, that Mencher’s wife and ‘several other colleagues and myself know of the greatest regard he had for you’. Would Titmuss provide a preface for the proposed book which was being put together by Mrs Mencher and Roy Lubove?23 Lubove was a Pittsburgh colleague of Mencher’s, and the two collaborated on a selection of English historical documents on welfare policy, a further example of Mencher’s historical interests and approach.24 In his immediate response, Titmuss told Lukoff how ‘shocked and saddened’ he had been by the news, and asked him to convey to Mencher’s wife ‘my sincere sympathy and sorrow at the loss of a friend and one of the most distinguished scholars in the field of social policy in the United States’. It went without saying, then, that ‘I should be very glad indeed to write a preface to Sam Mencher’s latest book and pay some tribute to his contributions in this country and the United States’.25 Private Practice in Britain: The Relationship of Private Medical Care to the National Health Service was published in the ‘Occasional Papers in Social Administration’ series. In his acknowledgements Mencher thanked Titmuss and Abel-​Smith for ‘much friendly advice’. Titmuss, here at his generous best, paid tribute to Mencher, ‘scholar, teacher, and friend’, noting the ‘profound sense of loss at his untimely death’ among all who were concerned with the ‘social problems of modern society’. Few Americans had ‘so well understood the social problems of their own society and of British society’. Mencher had ‘often returned’ to the common origins of British and American welfare in the Elizabethan Poor Law, while continuing ‘to puzzle about the divergent paths followed by social legislation in the two countries since the

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eighteenth century’. Mencher’s other posthumous work was an obvious case in point here. Titmuss then mentioned Mencher’s frequent visits to Britain, including his time at the LSE and at Manchester University in the mid-​1960s, where research for the present volume had been undertaken. Titmuss and his colleagues involved with the ‘Occasional Papers’ series were ‘glad to have had this opportunity to pay tribute to the contribution that Sam Mencher made to human welfare’. By the time Mencher came to publish his work, he was able to draw on not only Abel-​Smith and Titmuss’s work for Guillebaud but, as he noted himself, that of Eckstein and Lindsey.26

Researching Tawney: Terrill Titmuss owed, as we have variously seen, an intellectual debt to R.H. Tawney, and after the latter’s death in 1962 continued to engage with his ideas. In autumn 1969 he met with the Australian-​born Ross Terrill, at that point undertaking his Harvard doctorate on Tawney.27 Titmuss went on to read part of Terrill’s thesis, and to encourage and expedite its publication. So, for instance, in early 1971 he told Terrill that he and Kay had enjoyed his visit to their home, and hearing about his future plans. Titmuss had since approached his old friend Charles Furth, of the publisher George Allen and Unwin, about Terrill’s proposed book. Presumably nothing came of this as the book was ultimately brought out by another company, but the point here is Titmuss’s support for the project.28 A few months later, Titmuss informed Terrill that Kay and I  have read with immense fascination and mounting pleasure your Chapters 2–​5 on Tawney. They are so human, so vivid, and bring back so perceptively the flavour of the man and the feel of another age. I may be wrong but I would hazard a guess that in the not too distant future the ‘young in heart’ will rediscover Tawney –​thanks to you.29

While it would be wrong to over-​read this passage, part of a then private correspondence, it is nonetheless revealing in its encouragement for a younger scholar, its admiration for Tawney, and, perhaps, a sense of nostalgia for yet another ‘lost age’.The chapters in question concerned Tawney’s life from 1914 onwards, and his approach to equality, an issue with which Titmuss, too, had engaged. A couple of weeks later Titmuss reported that he and Kay had, with two American friends, visited the Cotswolds cottage once inhabited by Tawney. It still contained some of Tawney’s books, along with a

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scrapbook of the latter’s newspaper articles, and he suggested this might be of interest to Terrill.30 Even in the 1970s Tawney tourism was a rather esoteric pursuit, but the episode once more shows Titmuss’s interest in Tawney and, again, a kindness to the younger scholar.Titmuss was clearly keen on Terrill’s book proposal, writing to Jose Harris, in August 1971, that he was attaching ‘the 4 chapters on Tawney which I have received from my friend, Dr Ross Terrill of Harvard’, presumably the material which Titmuss and Kay had enjoyed so much. As with Terrill himself, Titmuss told Harris about Tawney’s Cotswold cottage, and that it was ‘certainly worth a visit’ if she and her husband were ever in the area.31 Terrill duly repaid his various debts to Titmuss. When his volume was published, in 1974, the ‘Acknowledgements’ cited as ‘Chief among the scholars and keepers of the public conscience who helped with this book’ his Harvard mentor, the political scientist Samuel Beer, and ‘Richard Titmuss, who encouraged me from London in a number of ways, not least by his own admirable work which finely expresses Tawney’s spirit today’. Flatteringly for its late subject,Terrill suggested that Tawney ‘thought more highly’ of Titmuss ‘than anyone else at the LSE at the time he left it’.32 This comment came in ­chapter 2, one of those which Titmuss and Kay had been sent by Terrill. The notion of Titmuss as a ‘successor’ to Tawney was a common one, and will be dealt with in this volume’s final chapter.

A transatlantic research project Finally, we look at a research project which originated in the US, was funded by an American Foundation, but also directly involved Titmuss and his colleagues. In February 1958, Odin W. Anderson, an American health researcher with the New  York-​based Health Information Foundation (HIF), visited Titmuss’s department. Anderson’s trip was prompted by an earlier visit, in 1957, by George Bugbee, HIF president, and it seems likely that he and Titmuss met. Bugbee was later to publish a brief article on his trip comparing English and French health systems.33 At the end of 1957, Bugbee told Anderson that the Foundation should carry out a study of the NHS, focusing in particular on funding, and the question of professional freedom. Of the former, he noted that ‘Fortunately,Abel-​Smith and Titmuss have already made as exhaustive a study as the paucity of data permit on the cost of the NHS since its inception’.34 Bugbee’s remark about the ‘paucity of data’ echoes Titmuss’s own observations in this area, and the latter may have been the original source of this comment. This was

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later repeated by Anderson, who noted that Abel-​Smith and Titmuss’s ‘seminal research report’ had revealed the service gaining a declining proportion of gross national product, ‘a simple fact not known to the policy-​makers. Such was the state of analysis of the operation of the National Health Service’.35 Preparations for Anderson’s visit began. Titmuss appears to have been involved from the outset, for he was copied into correspondence between Anderson and Ministry of Health officials.36 Anderson was later to imply that he had first met Titmuss during his own trip to Europe in the early 1950s. Given that he made this visit as a World Health Organization Fellow in Social Medicine, this is highly plausible.37 Whenever they actually got together, Anderson was to become a friend, and one of Titmuss’s regular correspondents. In the course of his 1958 visit, he met with 36 interested parties in London, Manchester, and Edinburgh, starting with Titmuss. He was, along with Abel-​Smith, given dinner at Titmuss’s home, where the discussion centred on possible contacts, and on various research findings. Anderson also had dinner separately with Abel-​Smith, his notes of the evening recording that he and Titmuss together embodied ‘just about all there is known factually about the British health services’.38 Anderson later recalled that Titmuss had been ‘most helpful in advice and arranging for contacts in the health system, particularly the Ministry of Health’.39 Clearly intellectually stimulated by what he found, on his return to the US Anderson produced a long report detailing his visit, during which he had talked to ‘strategically placed people who could give me an insight into the problems and issues in the administration and development of the National Health Service over the past ten years’. He also outlined the history of the NHS, and its funding mechanisms. Anderson concluded by putting the case for a research project on the history of the service, especially because the ‘many and various American reactions to the British National Health Service stem from [a]‌concern with our own development’.40 This project was to be realised at the LSE.As Anderson confirmed to Titmuss in spring 1958, it involved two students at the School, Robert Pinker and Frank Honigsbaum, researching and writing a ‘history of the organization and financing of personal health services in England and Wales since 1900 or so’.This was to be done under the supervision of Titmuss and Abel-​Smith, with the HIF awarding the LSE a grant of around £7,500 over two years. Costs covered included payments for Honigsbaum and Pinker, secretarial assistance, and honoraria for Titmuss and Abel-​Smith. Anderson reserved the right to draw on Honigsbaum and Pinker’s material for his own work on comparative

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healthcare systems, but agreed that they could, under Titmuss and Abel-​Smith’s guidance, also publish their own volumes.41 The proposal eventually worked its way through the two institutions, with Bugbee telling his executive committee in autumn 1958 that ‘We have made some investigations of the London School of Economics and we find that their reputation for integrity and ability is excellent’.42 In the event, the funding was channelled through Titmuss, primarily to support the work of Honigsbaum and Abel-​Smith. According to Anderson, this had mixed results, at least initially.Abel-​Smith produced two books, on the comparative history of hospital provision, and on the history of nursing (the former aided, as Sheard notes, by Pinker). The hospitals volume,Abel-​Smith acknowledged, had been undertaken following discussions with Anderson and with ‘the assistance of a grant from the Health Information Foundation’, and in part sought to explain the differences in hospital provision between Britain and the US.43 The nursing volume, contrary to Anderson’s recollections, does not appear to have been directly funded from HIF sources, although Abel-​Smith saw the hospital text as its companion. But it is worth noting for Abel-​ Smith’s praise for Titmuss. He claimed that his ‘greatest debt’ was ‘due to Professor Richard Titmuss who introduced me to this field, who has generously contributed many of its underlying themes, and who has read and commented upon the manuscript at no less than three different stages’. In the absence of the ‘continuing encouragement and support of the Titmuss family, this book would never have been completed’.44 By contrast, Honigsbaum, in Anderson’s account,‘had considerable difficulty in finishing anything he did’. During a subsequent visit,Titmuss asked Anderson to evaluate Honigsbaum’s dissertation, and both agreed that it was unpublishable. Various upsets followed, including a falling out between Titmuss and Honigsbaum. Eventually, the latter produced what Anderson later described as ‘a first rate book on the split in the British medical profession’.45 In this work, published some time after Titmuss’s death, Honigsbaum duly noted the importance of the HIF grant for his research, and Titmuss’s role in gaining it. For his time at the LSE, ‘as well as for advice and counsel extending over many years I  am indebted to the late Professor Richard Titmuss’.46 Anderson, meanwhile, had kept up his contact with Titmuss, but his attempts to gain funding for a comparative study of healthcare systems foundered, at least at the British end, and despite Titmuss’s support.47 Nonetheless Anderson went on to produce a comparative volume in the early 1970s which drew heavily, in the parts dealing with England, on the work of Titmuss and colleagues such as Abel-​Smith. In a passage which went to the heart of one of the dilemmas of the Titmuss approach

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to healthcare, and indeed social welfare generally, Anderson remarked that there were arguments for targeting the poor since under a universal system such as the NHS, ‘special problems may be obscured’. So ‘proponents of universalism such as Titmuss, Abel-​Smith, and Townsend do point out the inequities in current universalism because of deficient attention to special problems among the aged, widowed, and handicapped, many of whom are poor’. This came at the end of a rather pessimistic discussion of how best to provide equity, if it was to be provided at all, in healthcare.48

Conclusion In this chapter, we have seen Titmuss assist American scholars on a wide range of topics, from R.H. Tawney, to the history of social insurance, to contemporary, and comparative, analyses of healthcare systems.This further illustrates the breadth of his interests, as well as his generosity. It also, on occasion, gave him further platforms from which to expand on his views of the state of British and American society. His review of Lindsey’s book, for example, took the opportunity to argue that ‘ownership of an empire and nuclear power’ might not be indicators of ‘the good society’.Titmuss’s suggestions about how to arrive at such a situation were given a further outing in his critique of President Johnson’s ‘War on Poverty’, part of his attempt to create ‘The Great Society’, and the subject of the next chapter. Notes 1 Heclo, Modern Social Policies in Britain and Sweden, Frontispiece and pp x–​xi. 2 J. Harris, Journal of Social Policy, 5, 1, 1976, pp 87–​9. 3 H. Heclo, Journal of Social Policy, 4, 4, 1975, pp 435–​6. 4 TITMUSS/​7/​68, letters, 27 July 1960, Gilbert to RMT, and 15 December 1960, Gilbert to RMT. 5 B.B. Gilbert, The Evolution of National Insurance in Great Britain: The Origins of the Welfare State, London, Michael Joseph, 1966, p 12. 6 R.M. Titmuss, ‘Foreword’, in Gilbert, The Evolution, pp 7–​8. 7 D.C. Marsh, Public Administration, 45, 1, 1967, pp 94–​5. 8 H. Eckstein, Pressure Group Politics:  The Case of the British Medical Association, London, Allen and Unwin, 1960. 9 H. Eckstein, The English Health Service:  Its Origins, Structure, and Achievements, Cambridge, MA, Harvard University Press, 1958, pp xii, 259–​60. 10 E. Burns, Political Science Quarterly, 74, 4, 1959, pp 598–​600. 11 I. Hiscock, Journal of the History of Medicine and Allied Sciences, 14, 3, 1959, pp 408–​9. 12 TITMUSS/​3/​434, letter, 4 May 1960, RMT to Lindsey. 13 TITMUSS/​3/​434, letter, 11 May 1960, Lindsey to RMT. 14 TITMUSS/​3/​434, letter, 26 October 1960, RMT to Philip Unwin.

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Helping American scholars on British topics 15 TITMUSS/​2/​177, letter, 9 July 1962, Lindsey to RMT. 16 A. Lindsey, Socialized Medicine in England and Wales: The National Health Service, 1948–​1961, Chapel Hill, University of North Carolina Press, 1962, pp vii, viii, xii, 94, 355. 17 TITMUSS/​7/​71, letter, 5 February 1963, Lindsey to RMT. 18 TITMUSS/​7/​71, letter, 8 February 1963, RMT to Lindsey. 19 R.M. Titmuss, Medical Care, 1, 2, 1963, p 110. 20 TITMUSS/​7/​71, letters, undated but July 1963, Siminoski to RMT, and 1 August 1963, RMT to Siminoski. 21 ‘Foreword’, in S. Mencher, Poor Law to Poverty Program: Economic Security in Britain and the United States, Pittsburgh, University of Pittsburgh Press, 1967, p vii. 22 S. Mencher, The Relationship of Voluntary and Statutory Agencies in the Welfare Services: Loch Memorial Lecture 1954, London, Family Welfare Association, 1954, p 24 and passim. 23 TITMUSS/​7/​75, letter, 15 March 1967, Lukoff to RMT. 24 R. Lubove (ed), Social Welfare in Transition: Selected English Documents, 1834–​1909, Pittsburgh, University of Pittsburgh Press, 1966, with Introductory Essays by J. Duffy and S. Mencher. 25 TITMUSS/​7/​75, letter, 20 March 1967, RMT to Lukoff. 26 R.M.Titmuss, ‘Preface’, in S. Mencher, Private Practice in Britain: The Relationship of Private Medical Care to the National Health Service: Occasional Papers on Social Administration no 24, London, G. Bell and Sons, 1967. 27 TITMUSS/​7/​1, notes of a meeting, 29 October 1969, with Terrill, PhD student, Harvard University. 28 TITMUSS/​7/​1, letter, 15 February 1971, RMT to Terrill. 29 TITMUSS/​7/​1, letter, 6 August 1971, RMT to Terrill. 30 TITMUSS/​7/​1, letter, 12 August 1971, RMT to Terrill. 31 TITMUSS/​7/​79, letter, 17 August 1971, RMT to Harris. 32 R.Terrill, R.H.Tawney and His Times, London, Deutsch, 1974,‘Acknowledgements’, pp v, 67. 33 G. Bugbee,‘Comments on Government Medicine in England and France’, Journal of the American Medical Association, 22 March 1959, pp 1474–​8. 34 AHA, Papers of Odin W.  Anderson, AHA 2, file 3, box 8, memorandum, 29 November 1957, Bugbee to Anderson. I am grateful to Professor Sally Sheard for copies of this AHA material. 35 AHA, Oral Histories, AHA 1, typescript ‘Odin W. Anderson: In First Person: An Oral History’, p 62. 36 AHA, Papers of Odin W. Anderson, file 3, box 8, letter, 29 January 1958,Anderson to Miss B. Crawter, Ministry of Health. 37 AHA, Oral Histories, AHA 1, typescript ‘Odin W. Anderson: In First Person: An Oral History’, p 61. 38 AHA, Papers of Odin W. Anderson, file 3, box 8, Odin W. Anderson, ‘Interview Notes in Great Britain, February 10–​28, 1958’, pp 1, 5. 39 AHA, Oral Histories, AHA 1, typescript ‘Odin W. Anderson: In First Person: An Oral History’, p 61. 40 AHA, Papers of Odin W. Anderson, file 3, box 8, Odin W. Anderson,‘The British National Health Service:  A Review and Suggestions for Research:  February 10–​28, 1958’, pp 1, 2, 13ff. 41 AHA, Papers of Odin W. Anderson, file 3, box 8, memorandum, 23 April 1958, Anderson to RMT.

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RICHARD TITMUSS 42 AHA, Papers of Odin W. Anderson, file 3, box 8, memorandum, 11 September 1958, Bugbee to HIF Executive Committee, p 1. 43 B.Abel-S​ mith, The Hospitals, 1800–​1948: A Study in Social Administration in England and Wales, London, Heinemann, 1964, p x; Sheard, The Passionate Economist, p 138. 44 B. Abel-​Smith, A History of the Nursing Profession, London, Heinmann, 1960. 45 AHA, Oral Histories, AHA 1, typescript ‘Odin W. Anderson: In First Person: An Oral History’, p 62; Sheard, The Passionate Economist, pp 125–​6; author’s interview with Professor Robert Pinker, 2 November 2017. 46 F. Honigsbaum, The Division in British Medicine:  A History of the Separation of General Practice from Hospital Care, 1911–​1968, London, Kogan Page, 1979, Acknowledgements. 47 AHA, Oral Histories, AHA 1, typescript ‘Odin W. Anderson: In First Person: An Oral History’, p 63ff. 48 O.W. Anderson, Health Care: Can There be Equity? The United States, Sweden and England, New York, John Wiley, 1972, pp 200–​1.

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23 Titmuss and President Johnson’s ‘War on Poverty’ Introduction By the time of Titmuss’s first American visit, the momentum generated by President Roosevelt’s ‘New Deal’ of the 1930s had stalled under unsympathetic Republican administrations. Americans on the liberal left seeking to build on Roosevelt’s legacy, then, looked to a rather different reform trajectory, that of post-​war Britain, and to an individual, Titmuss, who was advancing, and reformulating, the field of Social Administration. In American academic life, meanwhile, there were no real equivalents of the department Titmuss was developing at the LSE. Proponents of social reform were often to be found in schools of social work, and in parts of the federal bureaucracy. America’s high-​ level public officials, though, were generally political appointments, which had implications for policy formation and implementation. America’s ‘weakness’ in the academic field of Social Policy, at least in an institutional sense, explains why Titmuss was to be (unsuccessfully) head-​hunted by American universities. Nonetheless, he did engage with American welfare issues, and this chapter focuses on his contribution to the ‘War on Poverty’ in the 1960s, with particular attention to his visits of 1962, 1964, and 1966.

Social welfare in 1960s America In 1960 John F. Kennedy, a Democrat, won the presidential election. He was committed, half-​heartedly, to measures of social reform. His assassination in November 1963 led to Lyndon Johnson taking over in the White House. Usually remembered for miring America in the Vietnam War, here what is important about Johnson was his other

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‘war’, the ‘War on Poverty’, announced in messages to Congress in early 1964, and the associated attempt to build ‘The Great Society’. This was, historically, the high point of federal government activism. Johnson had come to political maturity during the 1930s, telling an advisor that he was a ‘Roosevelt New Dealer’.1 A  range of reform programmes were undertaken during Johnson’s presidency, including the 1965 Medicare and Medicaid Act. Medicare effectively expanded social security provision to create health insurance for the elderly. Medicaid, funded out of general taxation, provided healthcare for the needy poor. It was symbolic that the Act was passed 30 years after the 1935 Social Security Act, cornerstone of the ‘New Deal’. The 1965 legislation was thus the culmination of three decades of agitation for improved healthcare overseen by the federal government, with the health budget tripling.As such, it was a defeat for the American Medical Association, and its longstanding resistance to anything remotely resembling socialised medicine. At the end of the 1940s, for example, it had more successfully campaigned, alongside the insurance industry and political conservatives, against any expanded health insurance programme.This took place at precisely the point when similar objections were being made to American Marshall Aid being used to help fund the NHS with, for example, The Chicago Tribune running a story headlined ‘British Socialism Runs on United States Money’.2 Some 15 years later Abel-​Smith reported that, in 1962, the AMA had sponsored a visit by a British doctor, and actively and successfully spread his message that socialised medicine had failed in Britain. Remarkably, this had provoked a rebuke by President Kennedy, just at the point when he was launching his modest proposals for compulsory health insurance for the elderly.3 The AMA’s campaign in the 1960s also utilised a recording of future Republican President Ronald Reagan, arguing that ‘One of the traditional methods of imposing statism or socialism on a people has been by way of medicine’.This was a longstanding argument of the political right, in America and elsewhere, against state-​provided healthcare, and should be seen in the broader context of Cold War fears about the threat of communism. Nonetheless, Republican Party opposition to any form of state-​sponsored medical insurance played a part in Johnson’s landslide presidential election victory in 1964.4 Welfare legislation in the US had, along with the concurrent civil rights measures of the 1960s, particular implications for race relations given the levels of deprivation suffered by African Americans. Aid for Families with Dependent Children, on which Titmuss’s friend Alvin Schorr worked, and on which many African American families relied, was a case in point. As Michael Katz puts it, the United States had its

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own ‘rediscovery of poverty’ in the early 1960s. But alongside ‘conventional uses of welfare’, the impact of the civil rights movement was to employ, for the first time, social welfare policy as ‘one strategy for attacking the consequences of racism in America’.5 Racial tensions were high in 1960s America and, along with anti-​Vietnam war agitation, Cold War conflicts, and the assassinations of not only John Kennedy but also his brother Robert, and civil rights leader Martin Luther King, made this a turbulent decade in the nation’s history. In seeking to promote his social programme Johnson employed the skills of former New Deal officials such Wilbur Cohen, another friend of Titmuss’s. Cohen had been trained at the University of Wisconsin, an institution traditionally concerned with issues of social justice, and had worked on the 1935 Social Security Act. He became, as Julian Zelizer puts it, the ‘consummate Social Security insider’. In the 1960s Cohen worked at the Federal Department of Health, Education and Welfare (HEW), becoming secretary in 1968. A few years earlier he had acted, again in Zelizer’s words, as ‘Johnson’s point man on Social Security and Medicare’.6 Jonathan Oberlander likewise sees Cohen as one of the principal ‘architects’ of enhanced Medicare, and ‘perhaps the most influential individual shaping Medicare since its beginnings in 1951’.7 On his retirement from HEW in 1969,Titmuss praised Cohen’s enormous contribution ‘in the social policy field as an academic and as Secretary of Health, Education, and Welfare’. Consequently, ‘I am sure we all have a great deal to learn from you’.8

Back in the USA How, then, did Titmuss involve himself with the US and its welfare policies during the 1960s? In what follows, we look selectively at his various interventions in order to pick out major topics on which he sought to engage American academics, social service workers, and policy makers. Titmuss also had more pragmatic reasons for visiting the US. As he told Sydney Caine prior to his 1962 visit, in addition to commitments at various universities he hoped to have meetings with two of the American foundations which had ‘supported some of the current research in the Department’.9 Titmuss was working for the Democratic administration even before the ‘War on Poverty’ was launched. At the most basic level, this is witnessed by his appointment, in early 1962, as a consultant to the Social Security Administration (he had had such a role in 1957, and would have again).The person with whom Titmuss corresponded over this was his friend Ida Merriam, another New Deal veteran, and by this

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point Director of Research at HEW.10 Shortly afterwards, one of the key intellectual influences on the ‘War on Poverty’, Michael Harrington’s The Other America, was published. As we shall see, Titmuss admired this work, which, as is often remarked, was brought to the attention of the wider American public in 1963 by Dwight Macdonald’s article in The New Yorker. Less well known is that Titmuss, too, was cited in this piece. Thanks to the work of Harrington and others, Macdonald wrote, the ‘extent of our poverty has become visible’. The same thing had happened in Britain, ‘where working class gains as a result of the Labour Party’s post-​1945 welfare state blinded almost everybody to the continued existence of mass poverty’. It was only when The New Statesman published a series of articles by Titmuss the preceding autumn, based on his new book Income Distribution and Social Change, that ‘even the liberal public in England became aware that the problem still persists on a scale that is “statistically significant”, as the economists put it’.11 Macdonald was thus bringing Titmuss and his findings to the further attention of America’s own ‘liberal public’. As Carl Brauer remarks, President Kennedy read both MacDonald’s essay and Harrington’s book, while the former was, initially at least, read by more people than the books it reviewed.12 Titmuss’s 1962 visit consisted of his usual heavy schedule. During an extended visit to the University of California in April, he gave a public lecture, preceded by a ‘Coffee-​Colloquium’ with graduate students from the Faculty of Anthropology-​Sociology, while the following day he attended a meeting at the Institute of Industrial Relations.13 From the last of these,Titmuss was told that the Institute was ‘delighted with your visit Tuesday’, and that ‘we deeply appreciated the opportunity of exchanging views with you’. An Institute member, moreover, had ‘already summarized your remarks on a local radio broadcast’.14 Another Californian correspondent was Milton Chernin, Dean of the School of Social Welfare, and clearly another for whom Titmuss had performed during his April visit. Chernin told him that he was ‘purposely sending this brief letter to your home so that you will read it when you, Kay and Ann are back in your own surroundings’. His School had enjoyed a successful academic year, but Titmuss’s visit was ‘undoubtedly the high point and most important development of the year, in the opinion of all of us. It represented the fruition of a desire of long standing and it served as a professionally exhilarating tonic to all of us’.15 Titmuss clearly struck a chord during his West Coast visit, for more praise came from the Emeritus Professor of Social Work at Berkeley, Walter Friedlander. A refugee from Nazi Germany, Friedlander had entered the US thanks to the sponsorship of one of the country’s leading

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figures in social reform, Edith Abbott. He told Titmuss ‘how much all of us have enjoyed your visit, your discussions and lectures, and above all, the opportunity to meet you again and to have your encouragement and stimulation for our work’. Titmuss’s lecture at Berkeley, ‘Britain’s Welfare State: Images and Reality’, had recently been broadcast by a local radio station. This was the ‘most appropriate timing’ as Congress was, at that point, debating Kennedy’s proposal for ‘a modest health insurance for aged people within the framework of the social insurance program’. The outcome remained uncertain, ‘but it was really good to have your address broadcast at this moment’.16 These Californian encounters again illustrate the positive reception Titmuss gained, at least among those with similar approaches to welfare provision. Of course, his correspondents were, to some degree, engaging in mild forms of flattery. Nonetheless, what is especially notable is Titmuss’s willingness to deal with individuals as well as groups, and the broadcasting of his ideas to wider, radio, audiences. And as Friedlander noted, it was at this very point that the federal government’s plans for welfare reform were, tentatively, beginning to get underway. Titmuss thus clearly had an impact on the social policy academics. He also, though, spoke directly to American government officials. In March 1962, Merriam told him that she had recently discussed a lecture he was to give, to a large meeting at HEW, with her colleague Bob Ball. Both he and Merriam ‘want badly to hear about the British Health Service and Professional Freedom and know that there are a substantial number of people in the Department who would be interested in that topic’.Titmuss agreed that this could be added to the schedule for his forthcoming visit.17 Ball told Titmuss, after his visit to the Bureau of Old-​Age and Survivors Insurance, that ‘We continue to hear enthusiastic comment about your sessions here’, that is, at HEW, and that Ball was aware ‘that members of staff also benefited considerably from discussions with you’.18 Shortly beforehand, an economist at HEW congratulated him on his ‘two informative talks on the National Health Service and the “Welfare State” which you were able to give here’, and asked for ‘5 copies of each talk for distribution to the Health Economics Branch of the Division of Community Health Services’.19 Later in 1962, Karl de Schweinitz contacted Titmuss. De Schweinitz was another distinguished researcher and teacher in American social welfare and social work, and a historian of English welfare provision.As a Senior Fulbright Scholar he had visited the LSE in 1956–​57, and his wife had played a part in the social work dispute (de Schweinitz himself played a lesser role in the affair, but, perhaps more rewardingly, played musical instruments with Ann). De Schweinitz noted the ‘enthusiasm’

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with which Titmuss’s ideas had been received at HEW, and at Brandeis University where, although formally retired, he still took occasional classes. Indeed, this enthusiasm was the ‘one saving factor’ in the face of the ‘disease which seems to infect The London School [and] runs through, as you know, the social sciences in the USA’.As such, the ‘most important “corner of the LSE” ’ was that where the ‘creed according to Lindsay, Tawney, and Laski’ was still being practised.20 This was, undoubtedly, an allusion to Titmuss’s own department. The reference to Tawney is obvious enough, while Harold Laski was a left-​wing political scientist based at the LSE.‘Lindsay’ was, presumably, A.D. Lindsay, a progressive educationalist and friend of Tawney’s who, like Titmuss, had spoken at 1939 Liberal Summer School. The ‘disease’ reference is rather more elusive, but may be a critique of contemporary notions, much criticised by Titmuss, of the end of ideology, or a shift in sociology towards abstract theory. As to the Brandeis visit, and not unusually for Titmuss on such occasions, he was involved in more than one encounter with staff and students.As Charles Schottland, Dean of the Florence Heller Graduate School for Advanced Studies in Social Welfare, told him prior to his visit, several meetings had been arranged, including several small group gatherings. It was left to Titmuss to choose a lecture topic but, the dean suggested, ‘I do know that the group would be most interested in observations you could offer on your national health service’.21 Once again, this interest on the part of Titmuss’s American hosts is significant, as is the timing. Schottland, a former social security commissioner and another New Deal veteran, was to build his School into one of the leaders in its field in America. Notable, too, is the number of occasions on which Titmuss spoke to institutions primarily concerned with training social workers, as suggested a symptom of the ‘weakness’ of the academic field of Social Policy in the US.

Addressing the issues But what, in more detail, did Titmuss have to say? In December 1964, that is several months into the ‘War on Poverty’, he addressed social security staff on ‘The Role of Redistribution in Social Policy’.Titmuss first pointed to what he described as the then prevalent ‘limited concept of social policy’, that is, the common perception that it consisted of ‘uncovenanted benefits for the poor’. This he largely attributed to the legacy of the Poor Law, which had lasted until 1948, and had ‘inevitably involved personal discrimination’. But while the system had changed, ‘a whole set of administrative attitudes, values and rites;

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essentially middle-​class in structure; and moralistic in application’ had been inherited. It had taken a considerable time to even partially eradicate such views and behaviour. But publicly provided services were only the tip of the ‘Iceberg Phenomena of Social Welfare’, with the hidden elements being fiscal welfare and occupational welfare.All three, largely operating separately from each other, had redistributive characteristics, but in different directions. So, for instance, the ‘pensions of the rich are more heavily subsidised by the community than the pensions of the poor’. Social service provision was, moreover, often subject to moral judgements in ways which did not apply in fiscal or occupational welfare, and here Titmuss cited the penalties which could be invoked against ‘cohabiting’ single mothers in receipt of cash benefits.22 For his American audience, though, probably the most important part of his speech dealt with the NHS.The ‘major positive achievement’ of such universalist services had been the ‘erosion of formal discriminatory barriers’, that is, the income barriers in place pre-​1948. Despite financial constraints imposed by Conservative governments, the service had ‘maintained the principle of equality of access by all citizens to all branches of medical care’. Its success was partly because the middle classes had not opted out of ‘socialised medical care’ as they had done in fields such as secondary education and retirement pensions. The middle classes’ ‘more articulate demands for improvement’ had, for example, contributed significantly to rising standards of hospital care. Here Titmuss generously cited Almont Lindsey. But as social policy analysts in both Britain and America were coming to understand, ‘equality of access is not the same thing as equality of outcome’.Among the issues here was the part played by the professions, and how they discharged ‘their roles in diagnosing need’ in, for instance, selecting patients for access to particular services. In ‘the modern world’, therefore, the professions were increasingly ‘the arbiters of our welfare state’, the ‘key-​holders to equality of outcome’, and important actors in determining ‘the patterns of redistribution in social policy’. On one level, this was a positive gain in that the operation of the ‘crude decisions of the economic market-​place’ had been replaced by professional judgement. Nonetheless, the middle classes had done better out of the NHS than lower income groups, especially the unskilled. This was not an argument against universalism –​to the contrary. But while it was a necessary ‘prerequisite towards reducing and removing formal barriers of social and economic discrimination’, it did not, and this was a key point, ‘by itself solve the problem of how to reach the more-​difficult-​to-​reach with better medical care, especially preventive medical care’.23

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Also in 1964, Titmuss spoke at the University of Washington’s School of Social Work on ‘The British Health Service and Professional Freedom’. He told his audience that he had visited the US a number of times since 1957, and, in the course of these trips, had become aware of the startling misperceptions of the NHS. The recently introduced Hospital Plan, and the ten-​year plan for community care, were both ‘consumer oriented rather than being dictated by professional preferences’. Although Titmuss did not mention this, both of these initiatives had come from his old Conservative sparring partner, and Minister of Health, Enoch Powell. The present shortage of doctors in Britain, meanwhile, was due to the misguided analysis of the Willink Committee which had reported on medical manpower in 1957, hence the rise in the number of overseas doctors. Summing up, Titmuss suggested that ‘the problems of medical manpower, of the growth of professional power, of the future of the general practitioner and of technology in medicine, are problems which are common to both our societies’. Fundamentally, they involved ‘the limits and responsibilities of professional freedom, and the limits and responsibilities of patient freedom’. Whether such issues could be resolved more readily ‘under the British system of “socialised medicine” I cannot predict. I can only hope’.24 On occasions such as these,Titmuss’s speeches can be seen as a form of reassurance to American social welfare specialists that there was nothing to fear from even a modest programme of socialised medicine –​to the contrary. Titmuss commented directly, too, on American policy. In March 1964 one of his most frequent US correspondents, Donald Howard of the School of Social Welfare at the University of California, sent him a copy of Johnson’s Special Address to Congress on the War on Poverty. Howard himself was ‘Frankly … quite disappointed in it’. Its problems included a failure to address income redistribution, alongside an overreliance on local programmes.25 Titmuss was ‘sure you are right in your general impressions; it seems to me [Johnson’s proposals] do not go to the heart of the problem’.26 However inadequate Howard found the War on Poverty, in 1969 he gave Titmuss an account of Republican Richard Nixon’s presidential inauguration. Howard had ‘fumed internally’ throughout ‘because of the utter lack of graciousness –​to say nothing of generosity –​towards LBJ and the past four years’. There had been ‘no word of gratitude that the country is still afloat, World War III hasn’t broken out, or that Civil Rights are still gaining and the so-​called War on Poverty still continues –​in a way’.27 Howard’s qualification about the War on Poverty again hints at its perceived shortcomings, undoubtedly shared by Titmuss.

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Titmuss was not always polemical in his American publications, or at least not obviously so. With Mike Reddin he contributed a piece on Britain’s social security and health systems to Encyclopedia Americana. This was a largely neutral description which noted, after a brief historical introduction, the main pieces of legislation in these fields. But when it came to further reading, the three works suggested were Essays on ‘The Welfare State’, Lindsey’s volume on the NHS, and Vic George’s book Social Security: Beveridge and After. The last of these concluded with a positive reference to Titmuss’s 1967 New Statesman 1967 article, ‘Universal and Selective Social Services’, and the statement, based on this, that the ‘social security system must be examined not only in relation to the other social services but to the economic system of the country’.28 If Americans were going to learn more about Britain’s ‘welfare state’ from Titmuss, it was to be on his terms. Titmuss was also at pains to help American colleagues. Around the beginning of the ‘War on Poverty’, he was asked to comment on a draft article by two friends, and frequent correspondents, Martin Rein and Mike Miller.The latter was at this point Professor of Sociology at Syracuse University, while Rein was Associate Professor of Social Work and Social Research at Bryn Mawr College.Titmuss told Miller that ‘Like everything you and Marty write I found this essay full of ideas and original insights’.29 The article in question, ‘Will the War on Poverty Change America?’, appeared in late summer 1965. It is returned to in the next chapter when we seek to estimate Titmuss’s impact on American thinking about social policy.

Talking to The Nation In 1965, Titmuss wrote an article for the progressive American publication, The Nation. He began by observing that poverty was now a ‘socially acceptable subject for public debate’ in Britain and the US, and that both had seen a ‘rediscovery’ of poverty. In America this was attributable to the civil rights movement, and to interventions, such as Michael Harrington’s, which had ‘helped to shift opinion in favour of the poor’. In Britain the ‘rediscovery’ had ‘mainly come from respectable Labour intellectuals, not from the extreme Left’, and its origins lay in a ‘nascent understanding of the limits of conventional welfare, and from a growing sense that after thirteen years of Conservative rule Britain is still a deeply class-​divided society’. But both countries now had ‘elected governments committed to act on the poverty question’. And, differences of approach notwithstanding, ‘certain general and often unstated assumptions seem to prevail in both countries’ –​or so

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it appeared to ‘a British student of welfare’ who had visited the US on a number of occasions, and had ‘learned much from American friends and colleagues in the fields of social policy and social work’. Both had seen, for instance, ‘a shift away from the naïve belief of the mid-​ fifties that poverty would gracefully succumb to economic growth’. This ‘new realism’ was exemplified by Johnson’s March 1964 message to Congress, from which Titmuss quoted, noting that the passage in question contained ‘no narrow, pathological definition of poverty’. Rather, it was ‘a challenge to action involving values, institutions and policies’.30 So far, so positive. But there were problems. The Job Corps programme, for instance, involved the ‘categorization of the poor by their personal characteristics’, in much the same way as the English New Poor Law distinguished between the ‘deserving’ and ‘undeserving’ poor. In a key passage,Titmuss argued that ‘if the “culture of poverty” ’ was responsible for the condition of individual poor people ‘then, logically, the social and economic system is blameless’. Such individuals were, effectively, being stigmatised, a situation exacerbated by separate programmes for the poor, rather than the allocation of ‘more resources to them through established, socially approved, “normal” institutions –​social security, tax deductions, education and training, housing and other acceptable routes’. To do the latter would get to the real heart of the problem, inequality. So while poverty had been rediscovered in Western capitalist countries, inequality had not, for to ‘recognize inequality’ involved ‘recognizing the need for structural change, for sacrifices by the majority’. This would involve a ‘painful war’, underpinned by an understanding of the ‘immense complexities and the political implications in a market economy of a realistic attack on the problems of underprivilege and inequality’. Quoting Voltaire’s contention that poverty weakens the courage of the poor, Titmuss suggested that ‘poverty programs in 1965 may weaken the courage of democrats to face industrial and technological change’. Such change was problematical because of, for example, the ‘growing impact of automation and new techniques of production and distribution in economically advanced societies’ which could render a section of the population unable to enter the workforce.31 Titmuss also renewed his attack on the ‘end of ideology’, and its argument that inequality had disappeared in Western societies as a result of economic growth and welfare ‘incrementalism’ (an ‘apt phrase’ employed by Miller and Rein). Here his particular target was Seymour Martin Lipset, the American political sociologist. For present purposes, though, what is especially notable is Titmuss’s claim that inequality

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was increasing, not decreasing, in both the US and Britain. He firmly scotched any notion that socialists objected to such disparities out of envy. Rather, they did so ‘because, as Tawney argued’, these disparities were ‘fundamentally immoral’. The key question was, therefore, what society saw as welfare’s purpose: ‘to universalize humanistic ethics and the social rights of citizenship or to divide, discriminate, and compete’. In place of the ‘conventional criteria of capitalism’ there was a need for ‘different rules to live by’ –​in particular,‘more examples of altruism to look up to’. Only then would it be possible to prevent ‘the deprived and unable from becoming more deprived and unable; more cast down in a pool of apathy, frustration, crime, rootlessness and tawdry poverty’. In achieving this, social policy,‘defined in the language of equality and change’, would be central, and it was here that ‘ethics will have to be reunited to politics’.32 What are we to make of this? The first point concerns Titmuss’s reference to Michael Harrington, and his contribution to the ‘rediscovery of poverty’. Harrington’s The Other America, published in 1962, had, in a consciously Disraelian manner and with a nod to J.K. Galbraith, identified ‘two nations’ coexisting in an ‘affluent society’. Tens of millions of US citizens enjoyed ‘the highest standard of life the world has ever known’. However, affluence could be morally corrosive. There was also, within the same society, ‘an underdeveloped nation, a culture of poverty’ whose members were ‘beyond history, beyond progress, sunk in a paralyzing, maiming routine’.33 This is all of a piece with Titmuss’s longstanding critique of those who believed in the elevating powers of economic growth. Second,Titmuss’s reference to the civil rights movement is important. Titmuss was a committed anti-​racist, well aware of the impact of immigration on contemporary British society. He was especially concerned to avoid misguided social policies which, in America, had increased the ghettoisation of, and discrimination against,African Americans. So, for instance, in 1967 Titmuss further noted that the ‘War on Poverty’, notwithstanding its ‘radicalism’, had not solved the dilemma of how to deal with the poor without stigma.This failure meant that social rights and civil rights had become mixed up with the issue of redistribution. Consequently, problems had arisen due to the belief that ‘poverty was the problem, and that the advance of the poor Negro could be presented as a pro-​negro enterprise’. The ‘War on Poverty’, in other words, had failed to see the problems faced by African Americans ‘as a universalist problem of inequality, social injustice, exclusion’. A technocratic approach, rather than one which recognised underlying structural and political issues, had thus been adopted.34 As we shall see in Chapter 25,

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Titmuss was highly critical of legalistic approaches to ‘welfare rights’ in New York City in the latter part of the 1960s, again because of the unintended consequences for African Americans. Third,Titmuss’s attribution of the ‘rediscovery of poverty’ to ‘respectable Labour intellectuals’, rather than the ‘extreme Left’, is notable.This was, no doubt, in part to reassure The Nation’s liberal and progressive, but not revolutionary, readership that his arguments were acceptable and achievable, not abstract and unattainable. Clearly,Titmuss saw himself as one of these ‘respectable Labour intellectuals’. He was careful, though, to acknowledge the problems of ‘conventional welfare’, alongside persistent inequalities in British society. But Titmuss had his eye too on the so-​called ‘New Left’, critical of both capitalism, and what they saw as the Labour Party’s timid approach. America, too, had its New Left. For its adherents, American society suffered from such deep pathological damage that it could not be cured by ‘ordinary politics’, and all that ‘corporate liberalism’ had achieved was a ‘warfare–​welfare state’ of which Johnson’s ‘Great Society’ programme was but the latest incarnation.35 Titmuss was clearly anxious to distance himself from at least some of these views, while sharing concerns about Labour’s ability to actually achieve much, the limitations of the ‘welfare state’, growing inequality in both Britain and the United States, and the efficacy of certain ‘War on Poverty’ initiatives. Next, what of Titmuss and ‘automation’? This was not the first time he had confronted the social and psychological impact of technological change. But his comments in The Nation would have resonated with his American readers. As Alice O’Connor points out, there were those in the US who saw further economic growth as the solution to the problem of poverty. Opponents of this view, though, whom she characterises as ‘left-​liberal analysts’, argued that persistently high unemployment levels arose from ‘Structural change, technology, and, especially, automation’, with ‘industrial, low-​skilled, and, especially, minority workers’ particularly vulnerable. The solution therefore lay in, for instance, more aggressive job creation programmes, and labour market intervention.36 Titmuss, certainly a member of the ‘left-​liberal analysts’ club, was thus engaging with American debates about the best way to deal with poverty. Such discussions are part and parcel of social policy debate and the history of welfare. But it was when Titmuss became overtly critical of the ‘War on Poverty’ that he began also to deal with one of the most contentious areas in welfare history and philosophy, our final point about his intervention in The Nation. To start on a positive note, Titmuss had been careful to acknowledge, at least initially, that Johnson’s message to Congress had been

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underpinned by ‘a challenge to action’ based not on a ‘narrow, pathological definition of poverty’, but rather one involving ‘values, institutions, and policies’. The key word here was ‘pathological’, for Titmuss then went on to critique the notion of a ‘culture of poverty’.37 Although hardly a new idea, nonetheless it began to gain particular traction in 1960s America. While subject to variations and nuance, essentially the argument was that the poor lived in a separate world from the rest of society (there are hints of this in Harrington), a world whose characteristics would be passed down the generations. The sort of interventions required, therefore, were those which modified behaviour, for example targeted social work interventions. Poverty could thus be portrayed as a sort of self-​regenerating sickness, a ‘pathology’, and it was but a short step to blaming the poor for their own condition since their behaviour was, by such accounts, out of step with the rest of society. It was such arguments that Titmuss sought to challenge. For him, this approach let the socioeconomic environment responsible for poverty off the hook. What was really needed was a concerted attack on inequality, and the treatment of the poor on exactly the same terms as the rest of society. There was a certain historical irony here. Earlier in his career, Titmuss had flirted with notions of the ‘problem family’, and on occasion himself used the term ‘underclass’, both expressions which are associated with the notion of a ‘culture of poverty’. More importantly, perhaps,Titmuss’s stance shows once again his antipathy to judgementalism. As John Welshman puts it,Titmuss ‘had always steered clear of the view that the poor might in any way be responsible for the situation they found themselves in’.38 Admirable as this may have been, it was later to lay Titmuss, and the Titmuss paradigm, open to attack from those who took a more jaundiced (or realistic) view of human nature. Although he was not to know it at the time, his Nation article came out just a few months prior to the publication of the Moynihan Report, which seemed to suggest pathological problems in African American families, and the riots in the Los Angeles suburbs of Watts. Both brought home, in a particularly acute way, issues of social welfare and race. They were to recur in an important intervention by Titmuss in 1966.

Chicago, 1966 The National Conference on Social Welfare’s 1966 Annual Forum was held in early summer in Chicago.Titmuss attended as part of a North American trip which also included visits to New York and Vancouver.

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The previous year, he had written to Mike Miller that ‘Wisely or unwisely –​I never know –​I have provisionally agreed to give one of the major papers at the Annual Forum … I am supposed to talk about “Social Policy and Economic Progress”.Any tips?’39 The conference proceedings’ editors remarked that in choosing as the meeting’s theme ‘Social Welfare’s Goal in Economic Growth’, the organisers had ‘stirred up a cauldron of intellectual fermentation and social concern’. Although there was one major goal, solving ‘the problem of poverty in the midst of plenty’, a wide range of opinion on how to achieve this had emerged. Putting the meeting in its broader context, President Johnson’s ‘Greetings to the Conference’ suggested that the ‘economic and social issues you will be considering this week are crucial in the attainment of a Great Society’. Johnson noted America’s ‘enviable position of prosperity and progress’, the platform from which the nation could ‘enrich life for those who have least without depriving those who are already enjoying the fruits of our rich economy’. Delegates were thus ‘blessed with an opportunity unparalleled in the history of mankind’, for as leaders in social welfare ‘it is to you that your fellow Americans turn to help furnish the practical means of translating choice into action’.40 Titmuss, the only non-​American speaker, had as his co-​panellist Margaret Hickey, an authority on social work and chair of the Advisory Council on the Status of Women appointed by Johnson.41 Titmuss’s talk was entitled ‘Social Policy and Economic Progress’. In the first published version, Titmuss acknowledged his ‘friends and colleagues in the United States whose writings have been a source of stimulation to me’; these including Burns, Merriam, Miller, Moynihan, and Schorr.42 His address started by observing that industrialised societies were ‘getting richer in material terms’, so raising the question of what path social welfare might follow. Would it be, for example, that all needs could be satisfied by individuals operating in private markets for services such as medical care? In Britain, such questions were being asked, especially by economists who were ‘more cheerful professionals these days than they used to be when they were specialists in slump and depression’.They were also being posed in the US by those such as Milton Friedman, a major intellectual influence on Titmuss’s opponents at the IEA (some of whose works he noted in his analysis of British economists’ views).This was, then, another round in the ‘conflict over individualism and collectivism’. For those favouring individualism, social policy’s fate was thus to ‘wither away as social welfare returns to its nineteenth-​century residual function of custodial care for a small minority of the population’.43

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Titmuss disputed such notions, as well as the idea that economic growth, and associated phenomena such as scientific progress, would treat everyone equally, so eradicating poverty and disadvantage. Economic growth could, instead, create social conditions which impacted most on particular individuals or groups. Such ‘disutilities of progress’ were partly caused by society’s ‘inability to identify the victims, to name and hold responsible the causal agents, and to measure in material terms the social costs of change and economic progress’. In the ‘realm of values’, furthermore, there were deeply held beliefs such as that ‘those who are excluded from society merit exclusion’, an example of the ‘social pathologies of other people’s progress’. Titmuss dubbed the view that economic growth would solve all problems the ‘optimistic automated model’. He then posed a series of questions for this optimistic view. Could the market, for example, ‘resolve the problem of ethnic integration and accommodation?’ This was ‘an important question now for Britain as well as for the United States’. But, for economists, the ‘social costs of change rarely enter into [their] calculations and models’. They measured what ‘they can more easily count’. At present, there was no means of quantifying materially social phenomena such as ‘slum life and Negro removal’, but society had to ‘remind ourselves continually about their reality’. This situation had arisen because we happen to be living in a scientific age which tends to associate the measurable with the significant; to dismiss as intangible that which eludes measurement; and to reach conclusions on the basis of only those things which lend themselves to measurement.44 Key to speculation about social welfare’s future role, and the allocation of social costs, was how to do away with the stigma associated with the receipt of certain social services. Titmuss cited a comment by Mike Miller on the ‘need in our society … for differentiation without stigma’. It was undeniable that ‘if we are effectively to reach the poor we must differentiate and discriminate, individually and collectively’. This was necessary if society wished to ‘channel proportionately more economic and social resources to aid the poor and the handicapped, and to compensate them for bearing part of the social costs of other people’s progress’. This somewhat understated remark indicates, once again, a crucial shift in Titmuss’s thinking, away from undiluted universalism to a more nuanced position where selectivity, albeit strictly controlled, was both necessary and justifiable. Returning to economic growth,Titmuss suggested that, in both Britain and America, it had been commonly predicted in the immediate post-​war period that ‘poverty would gracefully succumb to the diffusion of abundance’, and here he again cited his old whipping boy, Daniel Bell, and his ‘end of ideology’.

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Who would have dared suggest that ‘in 1966 one American child in four would be regarded as living in poverty, that in Britain the ‘immigration of about 750,000 “coloured” people from the Commonwealth (or less than 2 percent of the population) would result in illiberal policies and discrimination’, and that in both countries inequalities of income and wealth would have increased, with Britain, even more than America, showing a high level of concentration of such resources at the upper end of the social gradient.45 Titmuss conceded that progress had been made in certain branches of the social services, for instance American education and British healthcare, without which inequalities would have been even greater. But mistakes had been made, most significantly in seeking ‘too diligently to find the causes of poverty among the poor and not in ourselves’. If the poor were to be fully admitted to British, and American, society, ‘we shall have to widen our frames of reference. We shall have to shift the emphasis from poverty to inequality, from ad hoc programs to integrated social rights, from economic growth to social growth’.The latter might see ‘the rehousing of the poor … proceeding at a greater rate than the rehousing of the middle classes’, and smaller differentials in incomes and assets between rich and poor, colored and pink families’.These would be ‘quantifiable indicators of social growth that we could take pride in, the new status symbols of an “affluent society” ’.46 All this went down well with Titmuss’s audience. Ellen Winston, the conference’s president and a Federal Commissioner of Welfare, told him his address had been ‘masterful’, and the organisers were pleased that it would shortly be in print and thus ‘generally available’.47 Alfred Kahn, a Professor of Social Work at Columbia who had visited Titmuss and the LSE some three years previously, contacted him after his return to England. It was to be hoped that he had had time to ‘recover from the excessive exploitation which I witnessed in Chicago, Vancouver, and New  York’. He had ‘made lasting impressions everywhere and contributed to raising the level of on-​going discussions in several spots’. Trude Lash, a child welfare campaigner and close friend of the late Eleanor Roosevelt, had been ‘fascinated by your Chicago paper’, and Kahn was seeking, on Lash’s behalf, permission to have copies circulated to her colleagues.Titmuss wrote ‘yes’ next to this point.48 In fact, Lash and Titmuss had met after the Chicago conference, but before Kahn’s letter, for she had written to thank him for his presentation to the Citizens’ Committee for Children of New York. His audience had been ‘spellbound … and found it very difficult to let you go’.49 Intriguingly, there is also an undated note in Titmuss’s files on headed paper from the Conrad Hilton, Chicago, the venue for the 1966 meeting. It contains

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details of the radio show by the famous Chicago broadcaster, activist, and oral historian Studs Terkel. There is also a handwritten comment, ‘Studs Terkel arranged’.50 It is unclear what, if anything, came of this, but circumstantially it would appear that Titmuss appeared on Terkel’s show, a distinguished feather in his broadcasting cap.

Conclusion Titmuss was engaged with American social welfare, and his standing as an international authority meant that he was consulted on the subject by both academics and federal officials. He was likewise interested in the historical development of welfare systems, in America as in Britain. Titmuss also drew lessons from the American experience, mostly warnings about the unintended consequences of even well-​ intentioned measures. For example, while the linkage between civil rights and Johnson’s ‘War on Poverty’ was, on one level, commendable, on another racial discrimination might be increased, on account of measures which primarily targeted African Americans. Given that immigration was a hotly contested topic in 1960s Britain, it was, therefore, essential that its social services did not abet ghettoisation. At the heart of the issue, in America and in Britain, was not poverty as such, but rather inequality. The moral purpose of social policy should be its diminution, and this should be pursued in such a way as to avoid stigma and judgementalism.This did not mean, though, that selectivity should be ruled out as a policy tool. Notes 1 An early historical analysis is C.M. Brauer, ‘Kennedy, Johnson, and the War on Poverty’, The Journal of American History, 69, 1, 1982, pp 98–​119. Brauer interviewed a number of the officials involved in the ‘War’.The Johnson quote comes at p 114. 2 J.E. Zelizer, The Fierce Urgency of Now: Lyndon Johnson, Congress, and the Battle for the Great Society, New York, Penguin Books, 2015, passim and, for Medicare, pp 184ff; D.M. Fox, ‘The Administration of the Marshall Plan and British Health Policy’, Journal of Policy History, 16, 3, 2004, pp 191–​211, passim and citing The Chicago Tribune, p 199. For American social policy in the twentieth century, J.T. Paterson, America’s Struggle Against Poverty in the Twentieth Century, Cambridge, MA, Harvard University Press, revised edn 2000; and M.B. Katz, In the Shadow of the Poorhouse: A Social History of Welfare in America, New York, Basic Books, revised and updated edn 1996. 3 B. Abel-​Smith and K. Gales, British Doctors at Home and Abroad: Occasional Papers in Social Administration, No 8, Welwyn, Herts, The Codicote Press, 1964, p 13. 4 Zelizer, The Fierce Urgency, citing Reagan at p 189, pp 190ff. 5 Katz, In the Shadow, p 260. 6 Zelizer, The Fierce Urgency, caption to photograph of Cohen between pp 242–3, p 199.

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RICHARD TITMUSS 7 J. Oberlander, The Political Life of Medicare, Chicago, University of Chicago Press, 2003, pp 28, 30. 8 TITMUSS/​7/​77, letter, 19 March 1969, RMT to Cohen. 9 LSE/​Staff File/​Titmuss, letter, 10 October 1961, RMT to Caine. 10 TITMUSS/​7/​70, letter, 12 February 1962, RMT to Merriam. 11 D. Macdonald, ‘The Invisible Poor’, The New Yorker, 19 January 1963, p 91. 12 Brauer, ‘Kennedy, Johnson’, p 103. 13 TITMUSS/​7/​70,‘Schedule for Professor R.M.TitmussVisit to UCLA [University of California, Los Angeles], March 30–​April 3’. 14 TITMUSS/​7/​70, letter, 5 April 1962, Arthur Carstens, Administrator, Labor Programs, Institute of Industrial Relations, University of California, to RMT. 15 TITMUSS/​7/​70, letter, 17 April 1962, Chernin to RMT. 16 TITMUSS/​7/​70, letter, 19 July 1962, Friedlander to RMT. 17 TITMUSS/​7/​70, letter, 9 March 1962, Merriam to RMT; and letter, 14 March 1962, RMT to Merriam. 18 TITMUSS/​7/​70, letter, 8 May 1962, Ball, Commissioner, Department of Health, Education and Welfare, to RMT. 19 TITMUSS/​7/​70, letter,18 April 1962, David A. Pearson, Medical Economist, Department of Health, Education and Welfare, to RMT. 20 TITMUSS/​7/​70, letter, 30 October 1962, de Schweinitz to RMT; Oakley, Father and Daughter, pp 145–​6. 21 TITMUSS/​7/​70, letter, 12 February 1962, Schottland to RMT. 22 R.M.Titmuss,‘The Role of Redistribution in Social Policy’, Social Security Bulletin, 1 June 1965, pp 14–​15, 16, 17, 18. 23 Ibid, pp 19–​20. Reprinted in Commitment to Welfare. 24 TITMUSS/​3/​370, undated typescript (but annotated ‘Seattle University’ and ‘?1964’), ‘The British Health Service and Professional Freedom’, pp 1–​3, 7, 9, 18–​20. The University of Washington had a prestigious School of Social Work, hence the assumption of the venue.Titmuss was in the US in 1964 so the annotation need not signify serious doubt about the dating of the speech. 25 TITMUSS/​AO, letter, 17 March 1964, Howard to RMT. 26 TITMUSS/​AO, letter, 2 April 1964, RMT to Howard. 27 TITMUSS/​7/​77, letter, 21 January 1969, Howard to RMT. 28 R.M. Titmuss and M.J. Reddin, ‘Social Security and Health’, Encyclopedia Americana: International Edition: Vol 13, New York,Americana Corporation, 1971, pp 251–​4;V. George, Social Security: Beveridge and After, London, Routledge and Kegan Paul, 1968, pp 243–​4. 29 TITMUSS/​6/​702, letter, 8 January 1965, RMT to Miller. 30 R.Titmuss,‘Poverty vs. Inequality: Diagnosis’, The Nation, 8 February 1965, p 130. 31 Ibid, pp 130, 131. 32 Ibid, pp 132–​3. 33 M. Harrington, The Other America: Poverty in the United States, New York, The Macmillan Company, 1962, p 158. 34 R.M. Titmuss, ‘Universal and Selective Social Services’, New Statesman, 15 September 1967, p 308. Reprinted in Commitment to Welfare. 35 N. Birnbaum, After Progress: American Social Reform and European Socialism in the Twentieth Century, New York, Oxford University Press, 2001, pp 340–​41. 36 A. O’Connor, Poverty Knowledge: Social Science, Social Policy, and the Poor in Twentieth Century US History, Princeton, NJ, Princeton University Press, 2002, p 144.

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Titmuss and President Johnson’s ‘War on Poverty’ 37 Ibid, especially Ch 8, for an account of how this idea took hold in the US, and the Moynihan Report’s significance. 38 J.Welshman, Underclass: A History of the Excluded since 1880, London, Bloomsbury Academic, 2nd edn 2013, p 117, and the references to Titmuss for his flirtations with the notions of ‘problem families’ and ‘the underclass’. 39 TITMUSS/​6/​702, letter, 9 August 1965, RMT to Miller. 40 National Conference on Social Welfare, The Social Welfare Forum, 1966, New York, Columbia University Press, 1966, pp vii, ix. 41 Ibid, p 220; ‘Margaret A.  Hickey  –​Women’s Leader’ The New  York Times, 10 December 1994. 42 R.M. Titmuss, ‘Social Policy and Economic Progress’, in National Conference on Social Welfare, The Social Welfare Forum, 1966, p 25, n 1. 43 Ibid, pp 25–​6. 44 Ibid, pp 29, 30, 31–​2. 45 Ibid, pp 33, 34–​5, 35–​7. 46 Ibid, pp 37, 39. Reprinted, slightly modified, in Commitment to Welfare. 47 TITMUSS/​7/​74, letter, 30 June 1966, Winston to RMT. 48 TITMUSS/​7/​74, letter, 29 July 1966, Kahn to RMT. 49 TITMUSS/​7/​74, letter, 29 June 1966, Lash to RMT. 50 TITMUSS/​7/​7/​73, Undated notepaper, the Conrad Hilton, Chicago.The writing does not look like Titmuss’s.

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24 ‘One of the greatest human beings of our time’: Titmuss’s influence on North American thinking on social welfare Introduction In his obituary of Titmuss, Michael Young suggested that he was ‘more renowned outside his country than within, having a royal following in the United States’.1 When Abel-​Smith and Kay Titmuss prepared the posthumously published Social Policy: An Introduction, meanwhile, they remarked that Titmuss’s works were ‘widely read in the United States and elsewhere’.They had thus sought to ensure that ‘British institutions are readily intelligible to North American and other students of social policy’.2 And, as previous chapters have shown, Titmuss engaged strongly with American scholars and federal agencies, especially from 1957 onwards. He thus commented directly, on occasion, on American welfare initiatives, while also commending, in particular, the NHS to American audiences. He was, therefore, at the heart of transatlantic policy networks, wherein those on the liberal left sought to promote social welfare in the pursuit of a better society.These interactions were also personal, with Titmuss acquiring loyal friends and admirers in North America, just as in Britain. He clearly derived considerable satisfaction from virtually all aspects of these transatlantic contacts. So what was his impact on American ways of thinking about welfare, allowing that ‘impact’ is intangible and difficult to measure? Why was it that Ida Merriam, in her obituary, claimed that ‘Richard Titmuss was one of the great human beings of our time’?3 The aim here is to give a sense of how Titmuss was perceived by Americans working in the same field.

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‘I hope you know the extent of your influence here’ A number of American associates commented directly on Titmuss’s influence, or potential for influence. We saw in Chapter 21 that when Yale’s Eugene Rostow issued his invitation to Titmuss in the mid-​ 1950s, he suggested that his ‘testimony could have far-​reaching effects on American thinking’.This was a prescient remark in that the Sherrill Foundation Lectures on the NHS which Titmuss delivered atYale were among the first of his many contributions to the debate on healthcare reform in America, and complementary to his mission to enlighten US audiences on the true nature of Britain’s version of socialised medicine. Another leading figure in American social welfare and social work, and yet another veteran of the New Deal, Elizabeth Wickenden, thanked Titmuss in 1962 for taking time during his vacation to see her while she was in London. Their discussion had been ‘both provocative and tantalizing in the number of subjects it opened up for future exploration’. Wickenden hoped that Titmuss’s plans to visit the US came to fruition, and ‘that you will spare a little of your time from all the other eager claimants to continue our discussion’.4 Alfred Kahn wrote in October 1963 that he had returned to work in New York a month earlier, ‘but have just reached the point where I can write to you and others for what you have done to make the summer’s trip especially important to me’. Titmuss, and his LSE colleagues, had been ‘stimulating in so many ways it will be quite a while before I recover’.Their discussions had framed the rest of his visit, and ‘entered into some of my own planning for course work and research here’.5 Around the same time, Titmuss was contacted by David Hunter of the American philanthropic body the Ford Foundation. Hunter told Titmuss that, at the suggestion of Mike Miller, he had recently read Essays on ‘The Welfare State’.Titmuss’s insights were ‘keen and generally applicable in the United States as well as England. I hope we shall have the opportunity to meet some day’. Hunter included some papers with his letter (it is unclear what they were).Titmuss, in reply, noted that he ‘found them stimulating and marked with a sense of urgency. Clearly we have much in common’. He then suggested a meeting when he came to the US in November. Further correspondence resulted in an agreement to meet at the Golden Door Restaurant at New York International Airport.6 This was not Titmuss’s first, or last, contact with the Ford Foundation. In the mid-​1950s, for instance, he chaired the Advisory Committee of the Institute of Community Studies, established in London’s East End in 1953. In 1956, the news came that the Foundation had granted an award of £25,000 to the Institute

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in aid of its social research.7 Among the Ford Foundation’s interests were the impact of ageing on society, and it was from the Institute that Townsend carried out his research into the lives of old people. Again in late 1963,Titmuss was an invited speaker at a small meeting, held in Baltimore under the auspices of Johns Hopkins University, on pharmaceuticals in their social context. As the preface to the published papers noted, understanding this relationship was necessary because of, especially, the thalidomide tragedy in Britain.Titmuss’s own contribution, ‘Sociological and Ethnic Aspects of Therapeutics’, ranged widely, while focusing especially on one of his preoccupations, the doctor–​ patient relationship, and the need for clearly defined and regulated medical ethics in an age of increasingly ‘scientific’ medicine. But more significant, at least for this chapter, is Titmuss’s actual presence at the event, and the effect it appears to have had. The preface suggested that the meeting had involved a ‘small group of individuals from the United States and the United Kingdom’, each ‘an expert in his own field’. In fact, of the just under 50 participants, only a handful were from Britain (among the others were Sir George Pickering, Regius Professor of Medicine at the University of Oxford).This might, of itself, be seen as indicative of the esteem in which Titmuss was held by the early 1960s. He was certainly mixing with the great and the good of American medicine and pharmacology, for example Robert F. Loeb, Professor Emeritus of Medicine at Columbia University.8 Sending Titmuss the proofs of his essay a few months later, one of the editorial team told him that his paper had brought back ‘wonderful memories of the Conference and your visit to Baltimore … We will certainly have to see to it that our paths cross again soon’.9 A typically American pleasantry, perhaps, but revealing nonetheless. Martin Rein, meanwhile, reported in 1964 that Titmuss had undoubtedly ‘captured the heart of Bryn Mawr’, the prestigious women’s liberal arts college in Pennsylvania. Rein had been informed that Titmuss’s ‘evening lecture was unusually well received by our somewhat conservative college community and departmental advisory board’.The ‘avid interest of my social work colleagues both at Bryn Mawr and at Rutgers’ had been especially heartening.10 Rein, and his colleague Mike Miller, were quick to respond to Titmuss’s Nation article, noted in the previous chapter. Posing the question ‘Will the War on Poverty Change America’, they started off by reviewing contemporary opinion. Titmuss’s article, they suggested, demonstrated that ‘poverty cannot be eliminated with changing the structure of society to reduce inequalities’. Johnson’s programme was, by this account, a ‘gimmick’.11 It will be recalled that Titmuss had seen a draft of the piece without objecting to its content.

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And in an expanded version of their article, which acknowledged the help of, among others, Titmuss and Adrian Sinfield, Miller and Rein upgraded ‘gimmick’ to ‘dangerous gimmick’.12 Canada, too, was open to Titmuss’s ideas. He received an honorary Doctor of Laws degree from the University of Toronto in late 1964. His accompanying schedule included an address to Convocation, a public lecture on ‘Problems of Health and Welfare in East Africa’, drawing on his concurrent work on Tanzania, and participation in a seminar on ‘Community Care and the Mentally Ill’.13 Following the last of these, which had been organised by the Ontario Department of Health, the head of its Mental Health Branch thanked Titmuss, on behalf of the seminar’s attendees, ‘for giving us so much of your valuable time and excellent counsel’, his heavy schedule notwithstanding.14 It was around this time that Titmuss, as we saw in Chapter 17, was involved with the future of mental health services in Britain, and this almost certainly prompted his invitation from the Ontario government. Three years later, he received a visitor from McGill University in Canada.William Westley, Director of the university’s Industrial Relations Centre, subsequently thanked Titmuss ‘for talking to us and for the information you provided’. This was already proving useful ‘in the development of our paper on The Effects of Affluence and Education on Labour Relations’. A no doubt welcome fee for $100 was enclosed.15 Back with America, in March 1967 Titmuss received a letter from Donald Howard, his friend at the University of California.This started off with the cheery greeting,‘Congratulations, Grandpa!’Titmuss’s first grandchild had been born in January. Turning to academic business, Howard noted that he was soon to retire, and that this raised the question of a successor. As he flatteringly told Titmuss, ‘Naturally, I first thought of you, when it was said that we want the best person for the job’. Notwithstanding the hopefully transitory ‘Reaganism, Reactionism and Retreat’, southern California had many attractions, as well as being a ‘very exciting place in which to work on social policy’. The university paid good salaries, which, for the ‘right man’, could be made even better. What was ‘utterly disheartening’, though, about American social policy experts ‘is that there are so few of them’.Titmuss, along with colleagues such as Abel-​Smith, Donnison, and Townsend, ranked ‘above any of the social policy experts in our own universities, to say nothing of those in schools of social welfare’.16 Titmuss ruled out any move ‘for all sorts of reasons, personal, domestic and academic’, and was possibly getting too old ‘to move in any permanent sense’.17 This episode is revealing in a number of ways, but what is most notable is the esteem in which Titmuss was clearly held by leading US academics

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such as Howard, and the suggestion that the former was a prime candidate for a prestigious American university post. The last point reinforces the observation in the previous chapter about the weakness of the academic field of Social Policy in the US. Nor was Howard’s the only approach. A few months later Titmuss wrote to the Dean of the Graduate School at Bryn Mawr that he had been ‘honoured’ by the suggestion that he might be interested in the post of Director of the Graduate Department of Social Work and Social Research. This time citing purely personal reasons, Titmuss again declined.18 In 1970, a further honorary degree was awarded, this time by the University of Chicago. Harold Richman, Dean of the School of Social Service Administration, suggested that it might ‘interest you to learn that not since Jane Addams was honored some forty years ago has this University awarded an honorary degree to a prominent figure in the field of social welfare’. Addams would thus ‘at long last have some very distinguished company’.19 Addams, a sociologist, had helped found Chicago’s pioneering Hull House Settlement, and, for her activities in promoting the cause of peace, was awarded the Nobel Prize in 1931.20 To be bracketed with this heroine of US social activism was praise indeed. And, writing to Titmuss during what was to be his last illness,Wilbur Cohen, now at the University of Michigan, sent his best wishes for recovery. Titmuss’s ‘books and ideas’ had been ‘very helpful to us here in the United States. I hope you know the extent of your influence here’. Cohen then asked for any offprints of his articles which Titmuss might have,‘which I can share with our students’.21 The assumed applicability to American circumstances of Titmuss’s thought, and his usefulness to students, is striking. Titmuss’s potential contribution to American approaches to social welfare was also recognised in other, less obvious, ways, for example in addressing American college students taking study abroad courses.The Florida Presbyterian College summer school for 1969 heard Titmuss talk on ‘Reflections on the Welfare State’, with further contributions from Howard Glennerster and Mike Reddin.22 In 1971, meanwhile, Titmuss gave the same-​titled talk to the graduate students from the New York School of Social Work alongside contributions from, for instance, Frank Field on ‘Clients’ Rights’. That these universities sought out Titmuss and his colleagues for this sort of engagement is revealing, with the School of Social Work students also attending a class of over four weeks on ‘British Social Welfare Policies’.23 Clearly, the hope was that the American students would, at least to some degree, absorb the Titmuss message and bring it to bear on their own work on returning home.

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Titmuss was, then, heavily engaged with American social welfare policy and practice, and much admired by like-​minded colleagues in that country. He was also prepared to use his influence in the US to further the careers of junior colleagues at the LSE and, by extension, the scope and interests of the department. In June 1971 he wrote to Mike Miller about Glennerster. He included a copy of Glennerster’s curriculum vitae, and correspondence with Ida Merriam who was ‘investigating the possibility of getting a room for Howard to sit in at the Brookings Institute [sic]’. The latter was a prestigious, long-​ established body which carried out broad-​ranging research into public and social policy. Glennerster, in his mid-​30s with a young family, was ‘one of the most promising younger men in the Department’.Titmuss had discouraged him from taking on teaching and was, rather, looking into the possibilities of getting him a grant to support himself while in the US. Titmuss’s department was ‘now getting an increasing number of American students’, and it was important ‘that people like Howard should be helped to develop a comparative approach’.24 Glennerster got his room at the Brookings Institution, in his view because of the direct intervention of Merriam. He had won an award from the Nuffield Foundation based on the Brookings invitation, and, once in the US, worked on central government budgetary processes, both in that country and in Britain. Merriam ensured that he had ‘the run of the Social Security Administration’, and became a family friend. America was to be the comparator country for the rest of Glennerster’s academic career. He and his family paid frequent visits, with his daughter marrying an American and becoming head of a prestigious poverty research unit at a leading American university.25 Titmuss’s personal and professional concerns for a junior colleague thus passed down the generations. In a range of ways and on a variety of levels, the Titmuss message was impacting upon the United States.

Commitment to Welfare and North America By the time Commitment to Welfare was published in 1968,Titmuss had a host of American admirers. We saw in the last chapter that the academic and activist Michael Harrington had received Titmuss’s approval. Harrington repaid the compliment when he reviewed Commitment to Welfare in The New York Times, alongside books by Alvin Schorr, and Mike Miller and Frank Riessman. Harrington placed all three volumes firmly in the context of the incoming Nixon administration, which, he predicted, would end the ‘exceedingly modest gains made under the Johnson antipoverty program’. All the more reason, then, to embrace

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these three ‘important’, and ‘first rate’, works of a ‘uniformly high level of excellence’. When Kennedy had initiated research into American poverty there had existed a deficit not only in social investment, but also in ‘social ideas’.Texts such as those under review had to be engaged with if there was not to be, as in the 1950s under Eisenhower, an ‘intellectual recession’. Titmuss himself was a ‘leading British socialist thinker who has played an important part in the Labor party and Government’. Harrington found him ‘at his best and most informative’ when documenting ‘the need for a consciously re-​distributive policy’, an issue directly addressed in eight of the collection’s essays. Without such measures ‘the Welfare State will chiefly help the middle class and the rich; the “Diswelfare State” will continue to afflict the poor’.26 We have encountered Donald Howard fulminating about Nixon’s inauguration ceremony. But, in the same letter, he also congratulated Titmuss on gaining ‘with Commitment to Welfare, the “lead” review in The New York Times Book Review, issue of January 5th! The prominence is well deserved, indeed, and you were fortunate to have so sympathetic a reviewer as Michael Harrington’. Howard could not recall The New York Times ever featuring, over the preceding 30 years, welfare-​related material as a front page item. Therefore, ‘in case you missed it –​or to give your grandchild something to make a hat out of ’, he had enclosed a copy. Howard also claimed that the publishers were doing an ‘excellent promotional job on your book’.27 The potential hat recipient, Titmuss’s second grandchild, had been born in May 1968.28 Of the other two books reviewed by Harrington, Schorr’s explicitly drew on Income Distribution and Social Change when discussing the allocation of American public services in favour of the rich at the expense of the poor. Harrington also suggested that Schorr had utilised ‘The Social Division of Welfare’ in his discussion of US housing policy as an area where the rich were advantaged through tax breaks while the poor suffered ‘diswelfare’ –​poor services, poorly funded, for the poor.29 It is worth saying a bit more about Schorr, already encountered on a number of occasions. A couple of years before Harrington’s review, he had given advice to the Seebohm Committee, and he had almost certainly been put on to this by Titmuss. Now a deputy assistant secretary at HEW, Schorr was a longstanding admirer of Titmuss and had been a visitor to the LSE in 1962, shortly after Titmuss had visited his department in Washington. So, for instance, in his 1966 work on child poverty in the USA Schorr quoted approvingly from an important article by Titmuss on redistribution and social policy, discussed in the previous chapter.30 Schorr may also have attended the talk to social security staff at which this paper was first delivered. And Titmuss had

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been aware of Schorr since at least 1959, when, as we saw in Chapter 21, he had been asked by a federal official to comment on a paper by him on the Aid to Dependent Children Program. The Miller and Riessman volume acknowledged Titmuss as among those from whom the authors had ‘learned much’, and their book, like Schorr’s, drew on ‘The Social Division of Welfare’, and Income Distribution and Social Change. The latter, for example, had shown, just as Harrington had for America, that their respective social services ‘do not seem to be benefiting the poor as much as the middle classes’. It was obvious that ‘changes in social policy are necessary here’. In an intriguing aside, they also suggested that although Titmuss was a ‘seminal thinker in analysing changes in the social structure of the modern society’, he had been ‘largely ignored by American sociologists’.31 This was presumably not meant as a compliment to American sociology, obsessed even more than its British counterpart with ‘theory’, and it is revealing that Miller and Riessman saw no need to explain who Titmuss was when they introduced him in their text. Those actively involved in social reform and welfare policy certainly recognised the significance of Titmuss’s work. Albert Gollin of the Bureau of Social Science Research, a not-​for-​profit organisation based in Washington, also reviewed Commitment to Welfare.Titmuss had been ‘educating LSE students, British society, and the world as to the benefits and costs (“diswelfares”) of existing and alternative social welfare systems for several decades’. He had also ‘actively sought to reshape welfare policy’, so the essays under review were those of a ‘committed and unusually effective applied social scientist’. Gollin was especially impressed by a ‘persistent theme in Titmuss’s work’, how to ‘help society as a whole make more informed political choices’. Titmuss’s ‘thoughtful, forthright handling of normative issues’, and indeed the volume as a whole, showed the value of working across disciplines, and that the resulting analyses ‘can in fact be enhanced by a highly practical concern with the improvement of public policy’.32 In his copy of the review Titmuss underlined these last two passages, so presumably he was gratified by Gollin’s flattering comments.33 Another American admirer wrote to Titmuss, like Howard, shortly after Nixon’s election victory. This was an urban planner from East Cleveland, Ohio, Ronald Corman, who told Titmuss that he had been reading Commitment to Welfare, so ‘reminding myself how much your thought has meant to me’.What Corman had gained from it was the confirmation of his own vision of a ‘redistribution of economic power (from a national base)’, and that ‘ordinary citizens increase their influence over their own lives, through participation in important

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locality-​based decision-​making processes’.34 This was certainly an intriguing reading of Titmuss, who was undoubtedly interested in income redistribution, but perhaps less so in the direct, participatory democracy Corman appeared to be advocating. Having said that,Titmuss was keen that individuals have the freedom to exercise choice. Corman’s comments show, though, that Titmuss was being read not only by academics and policy makers on the East and West Coasts, but also by those with practical responsibilities in America’s heartland. Donald Howard not only forwarded The New York Times piece, he also reviewed Commitment to Welfare himself.A ‘heavy debt’ was owed to his friend by ‘students and teachers of social administration, by researchers, and by analysts of social policy all over the world’. Although the essays were primarily concerned with Britain,Titmuss’s ‘analytic methods can be instructive to policy analysts everywhere’. After more in the same vein, Howard concluded that Titmuss was not only ‘a man of study and of Academe … but is also engaged in political affairs, official position, and public debate’. The impact of his thought could thus be ‘quickly felt in the world of affairs, and realities in that world can influence his thought’.35 Understandably, Titmuss was pleased with such praise, telling Howard that his review was ‘just too embarrassingly kind’, and that he surely exaggerated.36 But there was no doubt that this, and the other positive reviews, marked a recognition of Titmuss’s ideas, and influence, beyond Britain’s borders.To be on the front page of the liberal New York Times must have been especially gratifying. Indeed, it can be argued that America notices of Commitment to Welfare were, overall, more positive than those from British reviewers.This may reflect the more ‘advanced’ state of scholarship in the field in Britain so that those in the US were, essentially, grateful for any sort of intellectual stimulus they could obtain.

Americans remember Titmuss’s death, and the responses to it, are dealt with in Chapter 29. But is worth noting here how American commentators, friends, and colleagues reacted.The obituary in The New York Times suggested that it was for The Gift Relationship, a work which had been ‘credited with having influenced the United States government in the preparation of legislation to regulate the private market in blood’, that he would be best remembered.37 First published in America in 1971, The Gift Relationship had a long and complicated history stretching back to the early 1960s, and is dealt with in detail in Chapter 27.38 But given its impact in the US, something should be said of it here. Essentially,

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Titmuss compared the systems of collecting blood for transfusion in various countries, but especially Britain and the US.While the former relied on voluntary donations and the NHS, in America financial considerations often came to the fore through the purchase, by commercial companies, of blood from paid donors. By Titmuss’s account, this led to shortages of supply, and blood of poor quality. The British system was more efficient, both morally and economically –​altruism triumphed over the market. This critique, based on extensive analysis of empirical data, and insights from a range of social sciences, helps explain the book’s impact on the United States where, partly as a result, federal policy was revised. The relationship between Titmuss’s work and policy change was made by both American and British commentators. Shortly after publication, Karl de Schweinitz, now in Washington, commended a ‘superb piece of creative genius’. Titmuss had the ‘rare ability’ to bring together ‘facts and ideas which hitherto no one has recognised as being related to each other’. ‘The impact of your craftmanship’, de Schweinitz concluded,‘is already being felt in the USA’.39 Also making the policy link, Elizabeth Wickenden, now a Professor of Urban Studies in New York, told Titmuss in late 1972 that his book had come out in paperback in the US, and that ‘the federal government is belatedly beginning to regulate commercial blood supply’.40 In a shrewd piece of marketing, Titmuss’s American publisher, Andre Schriffin, sent copies of the volume to the Republican congressman Victor Veysey. In May 1972 Veysey told Schriffin that he had passed them to, among others, one of the Democratic Party’s leading liberals, Senator Edward Kennedy, and that he hoped that ‘the message sinks in’.41 The context here was the recent instruction by President Nixon that HEW look into transfusion, while in 1971 Veysey himself had introduced a bill seeking to regulate blood banks.42 In Titmuss’s obituary in The Times, it was reported that The Gift Relationship was a best-​seller, especially in America. Shortly after its publication, Elliot Richardson, US Secretary of State for HEW in the Nixon administration, was ‘privately consulting with [Titmuss] on the problem.Within a year legislation was before Congress to regulate the private market in blood’.43 A.H. Halsey later noted the work’s ‘especially dramatic’ impact in America. He also cited the review of Nathan Glazer, an eminent Harvard sociologist briefly involved with the ‘War on Poverty’, who had written that no American could read The Gift Relationship without feeling ashamed.44 In summer 1973, Cohen sent Abel-​Smith a clipping from The Wall Street Journal outlining Nixon’s plans.While the article did not name Titmuss, Cohen clearly saw these

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proposals as, at least in part, generated by his recently deceased friend.45 The irony is that Titmuss influenced the right-​wing Nixon administration, much derided by those on the liberal left. To return to the immediate aftermath of Titmuss’s death, and the impact of his ideas, in a letter to Walter Adams, LSE director, the Dean of Social Work at the University of Michigan (now Cohen’s academic home) expressed the ‘utmost sadness’ on his faculty’s part at the news of Titmuss’s death. He was ‘one of the most outstanding figures in the field of social administration, and he brought to that field a keen intelligence as well as an enlightened humanism. His unique contribution will be sadly missed’.46 Ida Merriam, as we have seen, had no doubts about Titmuss’s ‘greatness’. She further noted his skill in social analysis, and a ‘sense of moral purpose that led from knowledge to social action’. Among his many professional interests was his conviction of the ‘potential value of comparative cross-​national studies’, as well as a concern with the problems of developing countries.Titmuss’s standing ‘was evidenced by honorary degrees from a number of universities in North America and in Europe’. On a more personal level, Merriam claimed that those who knew Titmuss remembered ‘not only the accomplishments, but also the warmth and generosity’, his concern for, and willingness to help, others, his attempts to seek something positive in any argument, and ‘his humour and appreciation of life’.47 Obituaries and letters of condolence are not, by and large, occasions for critiquing the deceased. Nonetheless, it is striking that these American memorials emphasise not only Titmuss’s intellectual activities and influence, but also his personal qualities. Shortly after Titmuss’s death, Cohen wrote to Abel-​Smith. Cohen regretted not having seen more of Titmuss recently, particularly when he had been involved with the federal administration. But there could be no doubt that ‘Richard certainly made a magnificent contribution and we shall all be the losers for his passing’. As he was shortly to do in more detail at the memorial service, Cohen recalled that when he and Titmuss had been at a conference in the Soviet Union a few years previously, they had discovered at the airport that they could not change Titmuss’s roubles into sterling. As Cohen put it, they had redistributed income ‘without any appreciable increase in welfare! I  shall always remember this experience for its humor and humility’.48 A few days later, at Kay Titmuss’s request, Abel-​Smith cabled Cohen asking if he would speak on Titmuss’s influence in the US. Cohen immediately agreed, subsequently declared himself ‘honored’ to be asked, and changed his travel plans accordingly.49 Cohen’s address, which also dealt with Titmuss’s human side, is returned to in Chapter 29. But here it is

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worth noting what he had to say about Titmuss’s influence. Cohen, it should be borne in mind, had been a highly placed federal official, and so in a position to provide an informed assessment of Titmuss’s impact. Cohen began by suggesting that to be a teacher, ‘especially a good teacher, is to influence eternity. To be a good and influential teacher is to be able to develop students who have rendezvous with the great issues of the time’.Titmuss had been ‘an outstanding teacher’, of which there was ‘no higher calling, no more respected role in human activities’. More than this, he was also an outstanding author. It was through his writings that Titmuss’s ‘teaching’ primarily took place in the US, for although he had visited America on a number of occasions, he was ‘known to many thousands of persons in the social security and social welfare fields’ only in this way. Titmuss was thus in ‘a distinguished line’ of Britons ‘who have had a tremendous impact on social policy in the United States’. Here Cohen listed a rather motley collection, including Lloyd George and Queen Elizabeth the First (an oblique reference to the origins of the English Poor Law). Cohen correctly observed that Titmuss would have probably disavowed some of those cited, but all, like Titmuss himself, had ‘had some significant impact on the social policies and social institutions of my country’. Titmuss thus belonged to the ‘giants of social policy who have moulded changes which affect the destiny of millions’. He had acquired, moreover, a ‘large and commanding role in social welfare discussions in the United States’, and Cohen predicted that Titmuss would have ‘an impact in some future administration as well’. Titmuss’s writings were ‘eagerly awaited and discussed’ in both official and academic circles, while the ‘quality of his ideas’ was ‘enhanced by the fact that he could not be criticized as being a Republican or a Democrat’. Rather tendentiously, Cohen thus argued that Titmuss’s ‘seminal ideas were apolitical in the American context’. He looked forward to posthumous publications which, he was convinced, would have an ‘impact in many countries besides my own’.50 Cohen claimed, too, that such was Titmuss’s importance in the US that that ‘I know he had an important and constructive impact on two Cabinet Ministers in the United States in two different administrations’. There were not ‘many Americans who can currently claim this unusual distinction’. It is clear that one of these ‘impacts’ related to the collection of blood. But what of the other? Cohen noted that Titmuss had extended the analysis of welfare to include occupational and fiscal benefits, for example the ‘allowances in the income tax which provide subsidies to higher income earners based on a rationale of social needs’. This new perspective had ‘necessitated a complete re-​examination of

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the government’s role in income distribution and social welfare policy in the United States’, given the ‘extensive acceptance’ of ‘the income tax as a social policy institution’.51 Unfortunately, Cohen did not spell out how, exactly, the tax system was reformed to achieve the aims he had outlined. However, cuts in income tax, which President Johnson saw as necessary to stimulate the economy, certainly affected all income levels, and resulted in a considerable increase in disposable personal income.52 But while the expansion of social security undoubtedly benefited previously disadvantaged groups, Johnson’s overall tax policy was far from redistributive.53 What Cohen was driving at thus remains opaque. But it is noticeable how often American writers and policy makers utilised, and engaged with, works such as ‘The Social Division of Welfare’ and Income Distribution and Social Change. Did their insights in some way make it into federal fiscal policy? Once again, a memorial service is hardly the place to enter into a critique of someone’s life and ideas. Nonetheless, Cohen’s generosity, both in his eagerness to attend and in the tone and content of his address, is revealing, and a testament to Titmuss’s standing in America. Cohen continued to carry a torch for Titmuss, publishing a piece about him in his university’s journal, The Innovator.54 A few years later, on receiving his copy of the posthumously published Social Policy, Cohen told Abel-​Smith and Kay that he was hoping to produce such a work himself, and that when he did ‘I will owe a great debt to Richard for his insightful contributions to this most significant area of intellectual and political study’.55 It is also salutary to note briefly a volume of Titmuss’s writings which appeared in the mid-​1980s, edited by Abel-​Smith and Kay, and with the revealing title The Philosophy of Welfare. The editors observed that the volume had come about at the suggestion of Mike Miller at a time when ‘governments on both sides of the Atlantic have been cutting back spending on social services’. This made Titmuss’s writings all the more relevant, and yet they were now ‘no longer readily available to readers in the United States’, while in Britain some of his works were about to go out of print. The editors had thus ‘consulted colleagues and friends on both sides of the Atlantic’ when compiling the present volume.56 Among the pieces included were Titmuss’s 1966 Chicago speech, discussed in Chapter 23, and a piece on blood in the American journal Trans-​action, discussed in Chapter 27. In his own contribution, ‘The Legacy of Richard Titmuss’, Miller recalled his ‘great excitement’ when reading ‘The Social Division of Welfare’ on its appearance in 1956,‘that initial and welcome Titmussian shock’. On re-​reading Titmuss’s work  –​‘I could hear his voice as I read’ –​Miller found it as relevant as ever in ‘these days of Welfare

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State austerity’. The present situation contrasted with ‘the flush of expanding social programmes of the 1950s and 1960s when Titmuss wrote much of his work’. Miller described Titmuss’s ideas, one central component being the question of ‘purpose’ –​what were the aims of welfare policy, how was it to be carried out, and what outcomes might it have? In what can be read as an acknowledgement that, at least on the political left, this sense of purpose had been lost sight of, Miller noted that such questions might be answered in different ways at different times: ‘the fact that an answer has changed may be only dimly understood’, while the ‘fact that new circumstances require new goals may be only belatedly recognized’. Titmuss had concentrated on ‘the fundamental issues of what social policies should do and on the effects of any choices that are made’. In an era when welfare was being ‘harried by Thatchers and Reagans’, policy initiatives could only be ‘defended and transformed into more effective instruments’ through clarity about their purposes. Titmuss himself had been ‘no rosy observer of social policy’, but had developed a ‘philosophy of welfare’. Such a perspective was ‘missed today’, making ‘the current task –​to defend and change the Welfare State’ difficult. In changing times, the work of Titmuss,‘the premier philosopher and sociologist of the Welfare State’, remained ‘a major source of the reinvigoration of the philosophy of welfare’.57

Conclusion There can be little doubt that Titmuss, and his work, was well received by those on the American liberal left. The latter, while operating in a radically different political environment, looked to their English colleague for ideas and inspiration. Their need was heightened by the constraints of, especially, the academic circumstances in which many of them operated at one time or another. It is therefore unsurprising that attempts were made to lure Titmuss to prestigious American universities. In this sense, and as many of his American colleagues attested, he undoubtedly had an impact in the realm of ideas, and so informed debates in that country about the direction of social welfare.As to actual policy, though, the only clear-​cut case comes with blood transfusion. Ironically, this occurred after the administrations which had appeared to promise most for social reform, and especially Johnson’s, had ended. To put all this in context, of course, we shall, ultimately, have to ask what impact Titmuss had on policy formation in his own country. Although hardly without its ups and downs, this part of the present volume has seen Titmuss expanding his ideas, and exerting influence over a wide field. But although his positive contributions continued

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there were, from the mid-​1960s onwards, issues and events which caused him considerable personal and professional grief. It is to these ‘Troubles’ that we turn in the next part of this volume. Notes 1 M. Young, ‘The Professor Who Had No “O” Levels’, The Observer, 8 April 1973, p 9. 2 B. Abel-​Smith and K. Titmuss, ‘Introduction’, in R.M. Titmuss, Social Policy: An Introduction, London, George Allen and Unwin, 1974, p 10. 3 I.C.M. (Ida Merriam), ‘Richard Titmuss’, International Social Security Review, 26, 3, 1973, p 359. 4 TITMUSS/​7/​71, letter, 24 September 1963, Wickenden to RMT. 5 TITMUSS/​7/​71, letter, 18 October 1963, Kahn to RMT. 6 TITMUSS/​7/​71, letters, 14 October 1963, Hunter to RMT; 21 October 1963, RMT to Hunter; 24 October 1963, Hunter to RMT; and 17 November, 1963, RMT to Hunter. 7 TITMUSS/​8/​9, Minutes, 21 June 1956, of the Fourth Meeting of the Advisory Committee, Institute of Community Studies, p 1. 8 P. Talalay (ed), assisted by J.H. Murnaghan, Drugs in Our Society, Baltimore, The Johns Hopkins University Press, 1964, ‘Preface’, pp v–​vi; R.M. Titmuss, ‘Sociological and Ethnic Aspects of Therapeutics’, in P. Talalay (ed), Drugs in Our Society, Baltimore, Johns Hopkins University Press, 1964, pp 243–​53; and the list of participants at pp 301–​3. Reprinted in Commitment to Welfare. 9 TITMUSS/​7/​72, letter, 20 January 1964, Jane Murnaghan, School of Medicine, Johns Hopkins University, to RMT. 10 TITMUSS/​6/​702, letter, 9 December 1964, Rein to RMT. 11 S.M. Miller and M. Rein, ‘Will the War on Poverty Change America?’, Trans-​ action: Social Sciences and Modern Society, 2, 5, July/​August 1965, p 17. 12 S.M. Miller and M. Rein, ‘The War on Poverty: Perspectives and Prospects’, in B.B. Seligman (ed), Poverty as a Public Issue, New York, Free Press, 1965, p 273. 13 TITMUSS/​7/​72, undated (but October 1964) ‘Schedule for Professor Richard M. Titmuss’. 14 TITMUSS/​7/​72, letter, 26 November 1964, B.H. McNeel, Chief, Mental Health Branch, Department of Health, Ontario, to RMT. 15 TITMUSS/​7/​75, letter, 6 October 1967, Westley to RMT. 16 TITMUSS/​AO, letter, 1 March 1967, Howard to RMT. 17 TITMUSS/​AO, letter, 26 June 1967, RMT to Howard. 18 TITMUSS/​7/​75, letter, 12 December 1967, RMT to Richard W. Foster. 19 TITMUSS/​7/​78, letter, 25 May 1970, Richman to RMT. 20 See Oakley, Women, Peace and Welfare. 21 TITMUSS/​AO, letter, 16 November 1972, Cohen to RMT. 22 TITMUSS/​7/​77, flyer for ‘Florida Presbyterian College –​Programme, 4th July to 19th August 1969’. 23 TITMUSS/​3/​370,‘Lecture Programme for 1971 New York University Graduate School of Social Work Seminar on British Social Welfare Policies, 1st July to 27th July’. 24 TITMUSS/​6/​702, letter, 30 June 1971, RMT to Miller. 25 Email correspondence, July 2016, Professor Howard Glennerster and the author.

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RICHARD TITMUSS 26 M. Harrington, ‘What’s To Be Done for the Other America –​Three Plans for the Nixon Years and After’, New York Times, 5 January 1969, ‘Book Review’, pp 1, 26. 27 TITMUSS/​7/​77, letter, 21 January 1969, Howard to RMT. 28 Oakley, Father and Daughter, pp 175–​6. 29 A.L. Schorr, Explorations in Social Policy, New York, Basic Books, 1968, p 266 and Ch 18; Harrington, ‘What’s To Be Done for the Other America’, p 1. 30 On Schorr’s 1962 visit, TITMUSS/​2/​140, letter, 12 April 1962, RMT to Gwen Ayers, British Sociological Association; A.L. Schorr, Poor Kids, New York, Basic Books, 1966, pp 168–​9. 31 S.M. Miller and F. Riessman, Social Class and Social Policy, New York, Basic Books, 1968, pp x, 7–​8, 10, 45, 50, n 22. 32 A.E. Gollin, Social Forces, 50, 3, 1972, pp 422–​3. 33 TITMUSS/​2/​115, copy of Gollin’s review of Commitment to Welfare. 34 TITMUSS/​7/​77, letter, 16 January 1969, Corman to RMT. 35 D.S.H. (Donald Howard), International Social Work, 13, 3, 1970, pp 48–​9. 36 TITMUSS/​7/​78, letter, 17 February 1970, RMT to Howard. 37 ‘Prof Richard Titmuss, Author of “Gift Relationship”, Is Dead’, The New York Times, 7 April 1973, p 36. 38 R.M.Titmuss, The Gift Relationship: From Human Blood to Social Policy, New York, Pantheon Books, 1971. 39 TITMUSS/​7/​79, letter, 17 March 1971, de Schweinitz to RMT. 40 TITMUSS/​AO, letter, 17 October 1972, Wickenden to RMT. 41 TITMUSS/​AO, letter, 16 May 1972,Veysey to Schriffin. 42 ‘Blood Bank Study Ordered by Nixon’, The New  York Times, 3 March 1972, pp 1, 24. 43 ‘Professor R. Titmuss: An Outstanding Social Administrator’, The Times, 7 April 1973, p 16. 44 A.H. Halsey, No Discouragement:  An Autobiography, Basingstoke, Macmillan, 1996, p 106. 45 COHEN, box 196, folder 5, letter, 3 July 1973, Cohen to Abel-​Smith, and attachment. 46 COHEN, box 235, folder 7, letter, 2 May 1973, Phillip A. Fellin to Adams. 47 I.C.M. (Ida Merriam), ‘Richard Titmuss’, pp 359–​60. 48 COHEN, box 196, folder 5, letter, 23 April 1973, Cohen to Abel-​Smith. 49 COHEN, box 196, folder 5, cablegram Abel-​Smith to Cohen, and reply and letter, 9 May 1973, Cohen to Abel-​Smith. 50 COHEN, box 235, folder 7, W.J. Cohen, ‘A Thanksgiving for Richard Titmuss: June 6, 1973, London, England’. 51 Ibid. 52 J.E. Zelizer, The Fierce Urgency of Now: Lyndon Johnson, Congress, and the Battle for the Great Society, New York, Penguin Books, 2015, pp 75–​82. 53 W.E. Brownlee, Federal Taxation in America: A Short History, Cambridge, Cambridge University Press, 2nd edn 2004, p 123. 54 COHEN, box 196, folder 5, letter, 29 August 1973, Cohen to Abel-​Smith. 55 COHEN, box 235, folder 7, letter, 17 March 1975, Cohen to Abel-​Smith and Kay. 56 B. Abel-​Smith and K. Titmuss, ‘Preface’, in B. Abel-​Smith and K. Titmuss (eds), The Philosophy of Welfare: Selected Writings of Richard M. Titmuss, London, Allen and Unwin, 1987, p ix. 57 S.M. Miller, ‘Introduction: The Legacy of Richard Titmuss’, in Abel-​Smith and Titmuss (eds), The Philosophy, pp 1–​7, 1–​2, 16.

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Part 5

TROUBLES?

25 The Labour government, social policy, and the Supplementary Benefits Commission Introduction When Labour returned to power in 1964, hopes were high for welfare reform. These were increased when, in 1966, Labour was re-​elected with an improved majority. But the economy proved troublesome, with, for example, unemployment on the rise. The circumstances for radical social policy innovation were not, therefore, necessarily favourable. However, many advocates of reform, including some close to Titmuss, became increasingly frustrated with the government. This resulted in, notably, the creation of the Child Poverty Action Group in 1965, a body which was to become a thorn in the government’s side and, increasingly, critical of Titmuss. This chapter discusses Titmuss’s response to this situation, how he continued to refine his ‘philosophy’ of welfare, and how all this affected his relationship with his colleagues. For example, on the issue of welfare ‘rights’ he was to engage in a ‘fierce’ debate with David Donnison.1 More formally,Titmuss became a member of the Supplementary Benefits Commission, retaining this position until his death.

The poverty lobby In autumn 1966, Crossman gave the last in a series of Fabian Society lectures. Among the earlier speakers had been Abel-​Smith and Townsend who, he recorded, had launched ‘a tremendous attack on the Government for its failure to abolish poverty’. He had delivered a ‘really rambunctious reply’ to a packed audience. Pointing out the

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difficulties the administration faced, Crossman questioned how, given it had only been in office for two years, more could have been done, especially in difficult economic circumstances.Titmuss,Abel-​Smith, and Townsend had been sitting immediately in front of him.The audience had been strongly supportive of them, and ‘obviously agreed with their accusation that the Government was losing its sense of direction and betraying its principles’. Nonetheless, his robust response ‘may have done a power of good’, as many Fabian Society members had been ‘deeply disheartened’ by the attack by ‘our own socialist professors and the enormous press coverage it got’.2 Crossman’s speech was published as a Fabian Tract. This opened with his stated intention of addressing Abel-​Smith and Townsend’s arguments. Crossman acknowledged that his understanding of poverty largely derived from working, in the mid-​1950s, with Titmuss and his two colleagues. But there was clearly a gap between ‘the socialist academic and the practical politician’.3 As if to confirm Crossman’s arguments, a few days after his original speech huge proposed public expenditure cuts were being reported as a means of addressing the country’s economic problems, with welfare expenditure especially at risk.4 Shortly afterwards, The Guardian carried an article by one of its senior journalists, Geoffrey Moorhouse, ‘The Poverty Lobby’ –​an early use of this particular expression. It was accompanied by photographs of Titmuss, Abel-​Smith, and Townsend alongside that of a child from the Gorbals, a notoriously deprived area of Glasgow and a favourite with editors when giving visual images of deprivation. The piece appeared shortly before Titmuss’s invitation to join the SBC, probably not a coincidence. Moorhouse suggested that ‘the myth’ that poverty had been eradicated ‘at some vague moment after 1945’ had finally been dismissed, and opinion ‘had progressed so far as a result of a sustained and skilful campaign conducted largely outside Westminster’.This had been ‘running for years, while we believed we never had it so good, before most of us were even aware of it’. Its leaders were Titmuss, Abel-​Smith, Townsend, and Lynes, now CPAG secretary. Although Labour’s 1964 election victory should have created fertile ground for the implementation of some of the Titmuss group’s ideas, this had not happened. Crossman had always been sceptical about one proposal, a large increase in family allowances, and ‘with economic difficulties piling on top of it from the word go the new Government was hardly likely to change its mind merely on the say-​so of its Fabian back-​room boys’.This had resulted in the founding of CPAG, and the publication, immediately before Christmas 1965, of Abel-​Smith and Townsend’s The Poor and the Poorest –​evidence of the ‘deftest strategy’. Consequently,

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‘strains between the campaigners and their friends in Government’ had arisen.There had been ‘no concealing Crossman’s irritation’ at the recent Fabian meeting, hence the dispute between social realists, on the one hand, and political realists, on the other. For the former the issue was not simply one of increasing the monetary value of certain benefits, and Titmuss’s comment that ‘this is not a question of poverty at all. It’s a matter of inequality’ was cited.5 Crossman clearly felt the government was vulnerable to attacks on its social programme, and that Titmuss and his colleagues were key players. At the start of 1967, he watched a television programme on poverty ‘based very largely on the campaign of the Titmuss group against the Labour Government for its maltreatment of lower-​paid workers with large families’. Obviously irked, Crossman spitefully remarked that ‘most of the mothers looked mentally deficient and one felt bound to ask whether free family-​planning might not be the solution’. All this, though, was ‘part of the social security campaign we have to face’.6 The programme was entitled ‘Poverty in Britain’, and broadcast by the BBC on its flagship current affairs programme, Panorama.The following day two related pieces appeared in The Guardian. The first noted a CPAG claim questioning the finances, and outcomes, of possible changes to family allowances. The second, ‘Settling the Battle Lines’, was by the recently elected Labour MP David Marquand, who argued that while economic growth continued to raise living standards, there were a number of ‘loopholes’ when it came to addressing inequality. Titmuss, Townsend, and Abel-​Smith had, ‘with dogged pertinacity and painful clarity’, shown that although economic growth ‘may blunt the edge of inequality for the majority it does the exact opposite for a minority. Relative poverty grows with absolute prosperity … Thanks to the Titmuss group this is now familiar’.7 But this group was soon to be under considerable strain.

Appointment to the Supplementary Benefits Commission One piece of reforming legislation which Labour did pass was the 1966 Social Security Act. This merged the National Assistance Board (NAB) with the Ministry of Pensions and National Insurance to form the Ministry of Social Security. In 1968, the latter and the Ministry of Health were brought together to form the Department for Health and Social Security. The Ministry of Social Security would be responsible for all social security benefits, both contributory and means tested, an administrative first. National assistance had delivered means-​tested benefits for those without sufficient income. The NAB had operated

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as an independent body, but its successor, the Supplementary Benefits Commission, was part of the new Ministry. National assistance was to be replaced by supplementary benefit. It, too, was means tested, and again aimed at those on low incomes. There were, though, changes in eligibility criteria, and, in principle at least, in the way the scheme was run and its underlying ethos. In early 1967, Peggy Herbison, Minister of Social Security and driving force behind the SBC, invited Titmuss to become a commissioner, telling him, too, that she had appointed Richard Hayward as chair, and that she was anxious that all Commission members ‘should have a wide knowledge and understanding of the social problems with which they will have to deal, and that the experience of the Commission as a whole will cover a very broad field’. Herbison acknowledged that, as ‘an entirely new body’, it was not yet possible to say how it would function. But her present understanding was that there would be monthly meetings, supplemented as circumstances dictated. Appointment would be initially for five years, at a salary of £750 per annum. Titmuss accepted.8 Herbison did not remain long in post, being replaced in summer 1967 by Judith Hart, like Herbison long known to Titmuss. In spring 1968, following an informal conversation, Hart offered him the post of deputy chair, with a salary of £1,250 per annum.9 Titmuss’s role as deputy chair survived the Labour government’s demise, and was confirmed in autumn 1971 by Sir Keith Joseph, Secretary of State at the DHSS.10 But to return to the initial appointment, Titmuss, one of eight commissioners, needed the LSE’s permission to take up his post, this being duly granted.11 Indeed, Sydney Caine strongly recommended this to the relevant committee, no doubt seeing it as another feather in the School’s cap.12 Hayward was already known to Titmuss. Like Titmuss, he had little formal education, and his biographer notes that, at the SBC, he sought to ‘entrench the idea of entitlement and end the stigma of state charity’, working ‘effectively with social-​policy experts such as Richard Titmuss’.13 The two got on well, and on Titmuss’s appointment as deputy chair Hayward told him that ‘You must know how delighted I am that you allowed yourself to be bullied into the Vice-​Chairmanship’. There was ‘much to do and together we can do it’. From time to time he would send Titmuss ‘bits and pieces which will not be generally circulated’. This ‘will keep you in close touch. I send you one today on the Immigrant issue’. Hayward concluded with the rather unconvincing reassurance, ‘I shall see you are not overburdened’.14

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The SBC’s role was explained in its first report. Its ‘main responsibility’ was the ‘determination of a person’s right to, and amount of, supplementary benefit’. Its officials could therefore exercise discretion. The Commission also had a wider role which involved playing a ‘full part in the formulation of policy’. It was ‘expected to offer advice to the Minister on matters which may arise out of the Commission’s experience in dealing with the many human problems in its field’. These, in turn, might ‘raise issues outside the administration of the Supplementary Benefits scheme itself ’, particularly the ‘connection between cash benefits’ and the provision of non-​monetary services. Commissioners also visited SBC offices and training centres.Two notable developments had been the creation of an inspectorate, which monitored services to claimants, and the appointment of a social work advisor. Various ‘practical difficulties’ were, though, acknowledged.15 Nonetheless, the Commission remained upbeat about its potential. The ‘Introduction’ to the first edition of its Supplementary Benefits Handbook, published in 1970, claimed that the 1966 Act emphasised ‘the concept of benefit as of right’. This was an attitudinal shift, both legally and socially, which the Commission wholeheartedly endorsed and encouraged.The rights of claimants went beyond legal entitlement to embrace the right to ‘courtesy and understanding relationships’, just as staff had the right to ‘expect understanding from the public in the difficult tasks and pressures of work that often confront them’. Such rights could not be ‘laid down or ensured by law or regulations’.16 Titmuss put considerable effort into his SBC work, while continuing to contribute more broadly to government policy. In spring 1968, Crossman, now Secretary of State for Social Services, asked him to help ‘urgently’ on a critical aspect of superannuation policy.17 Titmuss thus joined Crossman’s ‘pension’s circus’, other members being Abel-​Smith, Thomas Balogh, and Nicholas Kaldor.18 A few months later, giving an insight into the realities of policy making, the head of the Government Economic Service, Alec Cairncross, recorded that Crossman’s reconstituted ‘Brains Trust’ could not, collectively, agree a way forward, with funding being a particular issue. For Kaldor, the whole business was ‘eyewash’, to which ‘Crossman replied that of course it’s all eyewash [earnings related pensions] but none the less important’.19 Titmuss certainly thought so. In late 1969 he pointed out that he had recently contributed to the recent ‘major proposals for recasting the whole structure of social security in Britain’. He had argued, as a ‘socialist’, that the ‘issue of redistribution is critical in any new pension

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plan’.The proposed revisions were more redistributive than those operating in a number of European and North American countries. They were also more progressive than Labour’s 1957 superannuation plan, on which, of course, Titmuss had worked. Why, then, should the New Statesman, in which this letter was published, have attacked the proposed scheme, with a banner headline ‘Soaking the Poor’, while simultaneously accusing Crossman of adopting ‘an ideology of inequality’. He had scrutinised Crossman’s recent Fabian Society pamphlet, and found nothing to substantiate these accusations. To suggest that government proposals meant ‘ “Soaking the Poor” is, I am sorry to say, drawing-​ room nonsense’.20 By this point,Titmuss was apparently as irritated as Crossman by criticism from their erstwhile colleagues. As for ‘drawing room nonsense’, around the same time Titmuss decried what he saw as the abstract arguments, far removed from most people’s lives, of those behind ‘The Troubles’ at the LSE. The result of these deliberations, the 1970 National Superannuation Bill, had both selective and redistributive components. By Reisman’s undoubtedly accurate account, Titmuss was ‘bitterly disappointed’ when this fell following Labour’s electoral defeat that year.21

‘New Guardians of the Poor’ In 1969, Titmuss produced an account of the SBC, aimed at an American audience.Thanking officials for their input, he claimed that their recent discussion on ‘cash and welfare’ had forced him ‘to rethink some of the hackneyed phrases’ he had used previously, and in his essay. It was, then, ‘important that we have begun to tackle the need for a redefinition and restatement of welfare functions’, a further instance of Titmuss’s relentless intellectual self-​examination.22 The provocatively entitled ‘New Guardians of the Poor in Britain’ started with a historical overview of ‘public assistance’ –​essentially, cash benefits not derived from social insurance. When created in 1948, the NAB dealt with just under a million clients, with more than half aged over 65. By the time of the SBC’s inauguration, numbers had more than doubled. This was for a range of reasons, including a reaction against the immediate post-​war notion of a ‘subsistence minimum’.Accordingly, benefit increases had, since 1959, risen more sharply than wages and prices. At the time of writing, the number of SBC clients had further risen to some 2.5 million, of whom around 70 per cent were over retirement age.The Commission’s creation was thus not an ‘isolated act’, but ‘part of a broader movement of ideas and policies’ seeking to redefine

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‘the respective roles of different instruments of income maintenance and distribution’. Equally, it could be seen as part of the search for mechanisms to ‘reduce the role of discretion in income maintenance’. Its ‘essential statutory role’ was ‘one of policy formation in the administration of supplementary benefits’, and its ‘primary function’ to ‘provide supplementary cash benefits for those whose incomes are inadequate and need to be raised to a specified level’. Officials undertook some 17 million interviews. In so doing, they performed a ‘major welfare role’ requiring knowledge not only of their own scheme, but also of a wide range of social services. Such officials had, therefore, a ‘client advocacy function’ with regard to these other services, which in turn had ‘far-​reaching implications’ for staff recruitment and training.They were presently working ‘without the security of professional social work status’, notwithstanding that for many people they were ‘the only regular source of information, advice, and advocacy concerning the complex of health and welfare in modern society’.23 Given the ‘challenging tasks’ it faced, the SBC was ‘conscious of the need to develop new, unorthodox methods and techniques of administration, communication, and policy formation’. It had, for example, ‘appointed a distinguished social work consultant, one of whose tasks will be to assess the whole field of staff training in human relations’. Of course much work remained. Challenges included ‘inadequately trained and overworked staff, disgraceful offices, poor equipment, and insufficient levels of benefit’, problems exacerbated by growing client numbers. But at least some of these issues were being tackled, ‘in the firm conviction that public assistance can and must be redeemed and humanized in the interests of all citizens and not just the poorest groups in the community’. Ultimately, there was a need for ‘policies aimed at identifying categories, groups, and classes of income maintenance needs within the Supplementary Benefits program and transferring them, stage by stage, to expanding social security programs’. In the meantime, the ‘first phase’ of the Commission’s work was ‘of necessity to make sure that every person has his entitlement met and to see that the scheme is humanely administered’.24 Titmuss, like the Commission itself, saw it as having potential, while remaining aware of the challenges ahead. To illustrate this further, we now focus on three areas. First, Titmuss’s support for staff. Second, how he responded to attacks on the SBC by bodies such as the CPAG. And, third, how he sought to reconcile universalism with selection and discretion.Titmuss’s approach to these issues has much to tell us about his philosophy of welfare in the later years of his life.

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Defending the SBC: staff In December 1967, Tony Lynes invited Titmuss to address a CPAG/​ London Co-​Operative Society audience on the ‘Right to Social Security’. His fellow speakers included Michael Zander, a lawyer and LSE colleague, and the meeting was to attract around 450 people.25 Titmuss, an SBC commissioner for less than a year, took a pugnacious approach. Twenty five years after Beveridge, nearly ‘the whole British press is now campaigning for a return to the Means Test State’ on the grounds that poverty had been abolished by the ‘so-​called “Welfare State” ’. But to build a ‘Good Society’ it was necessary to construct ‘comprehensive, universal services available as of right to everyone by virtue of citizenship’. In what was, given his developing views, a carefully worded passage, Titmuss argued that society could not ‘advance towards these objectives by instituting wholly selective means-​tested services for poor people’. He called upon his knowledge of American social welfare, claiming that, in New York City, services targeted at the poor in practice almost exclusively embraced African Americans. ‘Legions of helpful lawyers and social workers’ might have won their clients ‘welfare rights’, but could not remove the ‘the sense of discrimination’ the city’s system engendered. In Britain, the NHS had ‘made a greater contribution to integration and ethnic tolerance than brigades of lawyers and platoons of social workers’. The SBC’s aim should be to reduce client numbers, so that ‘our objective should be to work ourselves … out of a job’. But the most important lesson he had learned since becoming a commissioner was the ‘appalling condition of many of the offices’ in which staff had to work, and the public had to be served. Some were ‘literally slums; there is no other word for them’. In such circumstances, and given an ever increasing workload, he had ‘nothing but admiration for the staffs who carry on working under these conditions’.They often had to deal with ‘difficult and truculent clients demanding their rights after waiting, perhaps, in slum conditions for two or three hours’. Unsurprisingly, staff morale was low, and turnover high.26 In summer 1971, meanwhile, New Society published an article, ‘Groomed to Give’, about an SBC training course. All staff entering at clerical officer or executive officer grades had to take such a course, and the author had sat in on a session led by Titmuss. Clerical and executive officers were low in the Civil Service hierarchy, and hence, in local offices, the Commission’s front-​line workers. The piece consisted of observations by the author, and verbatim commentary from Titmuss, and began by noting that Titmuss taught both LSE students and SBC

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staff. But while the former experienced several years of post-​school education, the latter had only these short courses. For Titmuss, this was a loss for both, as one of education’s functions was to ‘de-​culturise people from the confines of their own backgrounds’. SBC officers were always the first ‘to come face-​to-​face with entirely new social problems’, and were ‘asked to diagnose and assess the needs’ generated. But no ‘three-​week course’ could ‘equip a group of early school leavers with a few O-​levels’ with the necessary perspective for such a job. University students, on the other hand, were mostly middle class, and many, although they had ‘never had a conversation with a manual worker’, discussed in the course of their studies ‘poverty, unemployment and the sickness of society in theoretical terms –​in some of the new universities, in surroundings of luxury’.Titmuss found a ‘seminar with a group of clerical officers’ more intellectually rewarding. They brought with them ‘widely differing experiences’, wished to ‘understand the people who come to them’, and sought a rationale for ‘the policies they are administering’.Without such knowledge, they lacked ‘confidence in their ability to do their job’.27 A sense of how Titmuss approached these courses can be gained from notes he prepared for a session entitled ‘Dealing with People’, especially a suggested method of engaging with claimants when officials made home visits. Staff could adopt ‘A Casework Approach’ based on social casework (that is, as carried out by social workers). If the proper lessons were learned, all claimants would be treated with understanding, those requiring an especially sympathetic approach receive it, and the strain on individual officers minimised. Titmuss emphasised that this was an ‘Approach’, because ‘our job is neither to provide a “casework” service nor just an “income maintenance” service –​but a compromise between the two’.28 Consequently, Titmuss was an admirer of Olive Stevenson’s work as the Commission’s social work advisor. Stevenson had trained as a psychiatric social worker at the LSE in the early 1950s and, by the late 1960s, was teaching at Oxford University. Her role was, in the words of the Commission’s first report, to ‘advise on the performance of, and training for, those aspects of the work done under the Commission’s aegis which have analogies and connections with the functions of social workers’.29 In late 1968, Titmuss told his Oxford University friend A.H. Halsey that until recently he had not known Stevenson well, but she had a reputation as ‘one of the handful of intellectual leaders in the social work profession’. At the Commission she had ‘prepared two reports totalling some 150 pages.They are of outstanding quality’. Titmuss was, therefore, happy to support her application for academic

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promotion.30 Further commending the quality of the Commission’s research, in summer 1969 Titmuss told Hayward about a recently compiled document by the SBC inspectorate on the determination of claims at local offices. This was an ‘investigation into an extremely complicated set of problems’ which was, nonetheless, ‘first rate’. Many ‘so called “academic” studies on similar phenomena’ failed to achieve the ‘standards of analysis and objectivity which this Report shows’.31 As with his comparisons between LSE students and staff on SBC courses, Commission researchers come out better here than Titmuss’s university colleagues. In accepting re-​appointment as deputy chair, Titmuss again raised staffing issues. Since joining the Commission, he told Keith Joseph, he had become ‘increasingly interested in the manifold problems it faces and the role it attempts to play in our society’. Indeed, and without exaggeration, the SBC represented ‘one of the most important touchstones of what we mean when we talk about “a civilised society” ’. The more he studied similar systems elsewhere, the more impressed he was by the efforts of staff at all levels ‘to raise the standards of casework, to improve training programmes and to act responsibly and compassionately’. On the other hand, he was troubled by the ‘tremendous increase in recent years in the workload, and the consequent effects of deteriorating standards and lowered morale among staff –​particularly at local level’.32 Joseph agreed that staff were under pressure, and that they should be more highly trained.While his administration was determined to restrain Civil Service numbers, it was recognised that in a department such as his increases might be necessary. Signalling the shape of things to come for the public sector, he noted plans for the ‘development of management by objectives’.33 Titmuss also drew on his Commission experience to praise, and support, the Civil Service more generally. In a 1970 talk to the Civil Service College, he noted his time with the Cabinet Office in the 1940s, and his SBC role. Unlike some academic and political colleagues, he had developed a ‘deep respect’ for the service, praising its sense of responsibility, fairness, integrity, duty, and, in the case of the SBC, an ‘obsession’ with equity.34 A few months later, Titmuss was back at the college, when he spoke about the commission to assistant principals taking a course on social administration. It was ‘very kind of you’, he was subsequently informed, ‘to have displayed the interest that you did in this small group and to have talked to them so entertainingly well beyond the “advertised” time. As I think they made clear to you [they] … were glad of the opportunity to meet and talk with you’.35

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What can we make of Titmuss’s support for SBC staff? First, his commitment to positively engaging with civil servants is notable.These might be low-​g rade, but front-​line, officials, or, higher up, involved in policy making or policy analysis. His comment that he got more intellectual stimulus from SBC staff than LSE undergraduates may be a piece of Titmuss exaggeration. But he did put a lot of energy into this work, as he did to all his teaching, and evidently gained insights from it. His remark about the about the ‘theoretical’ approach of LSE students echoes comments made during ‘The Troubles’ there, while that about the privileges enjoyed by undergraduates had a long pedigree. Second, as Titmuss repeatedly argued, there was certainly a need for educating SBC staff. In 1972 he recorded that during a visit to the Surrey training centre the overwhelming majority of attendees had not heard of the Commission’s Handbook, nor of a recent report on the contentious issue of cohabitation.The Handbook, also controversial, had been published in 1970. It was, then, alarming that these members of staff, admittedly junior and new, were unaware of its existence. One clerical officer had, moreover, given him ‘a pretty grim picture of the hostile atmosphere’ in her Birmingham office.36 Nonetheless,Titmuss clearly had faith in what SBC front-​line staff were trying to do. He was prepared, too, to draw on the insights of other welfare professionals, notably social workers, to enable local officials to better understand, and carry out, their jobs. Third, what of the SBC as the ‘touchstone’ of a ‘civilised society’? While Titmuss had a vested interest in talking up the Commission’s positive characteristics, there is no reason to doubt his sincerity. What is, perhaps, most striking is his belief that the SBC had the potential to act as a humane, compassionate, vehicle for allocating benefits. As we shall see, this complements his view that discretion, as exercised by Commission officials, could be sensitive and supportive, rather than stigmatising.The role of SBC staff, and the Civil Service’s fundamental ethos, were crucial here.We are thus moving towards a welfare system which could encompass, in a positive way, more than simply the ‘automatic’ benefits derived from insurance contributions, or from prescriptive welfare ‘rights’.

Defending the SBC: critics In a 1969 Fabian Society pamphlet, the lawyer Anthony Lester addressed the issue of ‘why the A-​code issued to guide officials in awarding benefits has never been made public’. The minister responsible had argued that publishing the code would not be ‘the simplest way of

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informing people of their rights’. Discretionary powers allowed by the 1966 Act meant that individuals might be treated differently, so individual officers might take account of ‘not only things you could put down on paper but things like the psychological circumstance of the family’. Were the code to be published, ‘this discretion would become meaningless’. Lester disputed this, arguing that publication would ‘only ensure that such discretion was exercised in accordance with the regulations’. Benefit recipients were ‘surely entitled, as a matter of elementary fairness, to know the official criteria’ employed in assessing claims. This was not least so an informed challenge could, if necessary, be made to a social security tribunal. While entitlement to social security had been established by the 1966 Act, ‘the Ministry seems reluctant to treat it as a legal right, rather than a privilege to be awarded in a spirit of benevolent paternalism to the deserving poor’.37 For those who knew their welfare history, like Titmuss, phrases like ‘benevolent paternalism’ and ‘the deserving poor’ must have hit hard, recalling as they did the judgementalism, and cruelty, of Poor Law relief. Lester’s intervention caused a stir at the Commission. But Titmuss, who knew him, told Hayward that he had ‘always regarded [Lester] as a reasonable and sensible lawyer’ who had been ‘misled’. Titmuss would be ‘glad to sign a letter to him drawing his attention to some of the weaknesses in his arguments, and setting out the case against the publication of Code A’. After discussion with Michael Custance, the DHSS’s chief advisor to the SBC, a letter was duly drafted.38 The high level at which Lester’s commentary was dealt with is notable, indicating that he was taken seriously, and that the Commission was sensitive to criticism of this sort. Titmuss informed Lester that he had been drawn to his pamphlet because of a growing interest in ‘welfare rights’, an interest which was partly academic, partly derived from his SBC role. But some of Lester’s comments were worrying. For instance, ‘one should … do all one can to promote understanding of the [SB] scheme’, but ‘publication of the A code is not … the answer’. The code was nothing ‘sinister’. Rather, it was a compendium of matters such as office procedures. Moving on to discretion,Titmuss felt ‘very strongly that the discretionary element in the SB scheme is one of its most important features, because it tends to work in favour of the claimant not, as many suppose, against him’. Precise rules had, by definition, to be uniformly applied, and so ‘the provision they make for need will never be tailored to meet the extreme or exceptional situation’.Without discretion, claimants would get what the rules laid down, but ‘less and less easily will be able to get more’. Consequently, what individuals received would be of a ‘standard

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representing no more than average needs’. Titmuss had seen this sort of system in operation in American cities such as New York, and had been ‘not less than appalled at the shocking consequences for claimants, for claimant/​staff relations and for the whole atmosphere and good name of the welfare operation in question’.39 Lester acknowledged that they were ‘not as far apart as I at first imagined’. Discretion was ‘an essential part of our welfare system’, and generally exercised ‘fairly and in favour of the claimant’. He agreed that ‘the American welfare structure is scarcely a model for this country’.The rules, though, should be more transparent.40 Titmuss was pleased at this level of consensus, believing that they differed ‘only on the practical question’ of how much information to publish about the guidance given to staff without jeopardising ‘the discretionary element which is an essential feature of the system’.41 There was, though, no let-​up. In January 1970, Frank Field, on behalf of the CPAG, contacted a number of professors ‘concerned with social policy’. A letter was being drawn up, to be sent to The Times, urging the government to increase family allowances at the next budget. Would these professors agree to be co-​signatories? On Titmuss’s copy, he wrote ‘no’.42 The letter appeared on 2 March, signed by, among others, Townsend and Donnison, but not Titmuss. It argued that ‘special priority’ should be given to low income families, now relatively worse off than when Labour took office in 1964.43 A few weeks later, a piece entitled ‘Under Labour, the Poor Get Poorer’ appeared in The Sunday Times. This described the letter to The Times, noting that Titmuss, Abel-​Smith, and two of their junior colleagues had declined to endorse it. Abel-​Smith’s position was ‘understandable’, as he was an advisor to Crossman. But Titmuss, ‘with no official post yet bound by the loyalties of a lifetime’, had ‘remonstrated angrily with the other signatories’, arguing that they were merely providing the Conservative Party with ammunition. Some were now concerned that Titmuss might respond officially on the government’s behalf, but to have a public dispute with him, claimed one, ‘would be like killing the King’. Among the many ramifications of this disagreement, the piece concluded, was that Titmuss, Abel-​Smith, and Townsend, ‘three of the most able social scientists of their generation, the massive triumvirate of the 1950s’, had ‘parted company’. An accompanying photograph was captioned ‘loyalist Titmuss’.44 A week later, Field told Titmuss that he was ‘afraid that I am responsible for a couple of the points about you appearing in the Sunday Times’. He wished to meet in person, so as to ‘apologise and also explain how some of the information was used in a very different way to which

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I gave it’.45 A meeting duly took place, Titmuss recording that Field had explained how the journalists had ‘extracted information from him and he apologised for his part in the regrettable affair’.46 The matter, though, did not rest there. Titmuss engaged in a strained correspondence with The Sunday Times, and had a letter published on 29 March. But he then claimed that a crucial sentence had been omitted, and he wanted to know why. No satisfactory response was obtained.47 Titmuss was clearly furious, having an LSE employee contact the Press Council, the newspaper industry’s regulatory body, about the deleted sentence. The Council’s response was not clear-​cut, although it did suggest that, with regard to letters, editors had ‘unlimited discretion’.48 The most important point here, though, was the article’s identification of a rift between Titmuss and Townsend.The two were, in fact, already at odds, but this episode can have done little to heal the wound. Shortly afterwards, Audrey Harvey reviewed the recently published Supplementary Benefits Handbook. She recalled her interview, some years previously, with the NAB’s chair, who had defended his Board’s reluctance to publicise its discretionary benefits on the grounds of excessive costs. Harvey then sarcastically suggested that ‘I am sure that Lord Collison [Hayward’s replacement as SBC chair] … is too concerned about poverty ever to give such an answer, even if he did not have Professor Richard Titmuss, no less, sitting at his right hand’.Admittedly, the Handbook, aimed as it was at social workers, would allow them to help their clients. But it was no substitute for the ‘famous “Code A”, the still-​unpublished book of directives to local officers’ on the use of discretionary powers.The Handbook thus had to be viewed in the context of a ‘system of arbitrary censorship which would not be tolerated for a moment by those who get other forms of state assistance, such as allowances against tax’.The SBC’s claim that its scheme allowed for basic rights along with flexibility was, moreover,‘a shade euphemistic’, albeit that ‘no flexibility would be disastrous’. Nonetheless, claimants’ rights were ‘still subject to a home visit and are largely vitiated, for people under pension age, by the continuing discretionary powers of officers to withhold or reduce allowances’. Appeals could be made to tribunals, but these were not open to the public or the press and hence not subject to scrutiny. Harvey then made specific points about particular practices, including the ‘most interesting sin’ of cohabitation, which might result in young mothers having their allowances ‘whipped away’ thanks to the operations of ‘special investigators, using poison-​pen letters as a pretext, and much else of great nastiness besides’. What Harvey was getting at was the widely held notion that officials, looking into unmarried women’s claims, delved into their personal

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lives to find out whether a male partner was routinely present, and thereby possibly contributing to household income. For Harvey, such practices potentially brought the SBC into disputes about ‘ethics and morals’. The failure to publish Code A was, ‘on the grounds of justice, indefensible’, and she speculated that the Commission had ‘too poor a view of public opinion’ when the latter was ‘more sympathetic about poverty than it has ever been’.49 In his capacity as SBC deputy chair, Titmuss drafted a letter (which does not appear to have been published) to the New Statesman, publisher of Harvey’s review. He berated the ‘stupidity and prejudice’ of the House of Lords during a recent debate on the payment of supplementary benefit to students with dependants. Those who had written on the subject to New Statesman had, moreover, excelled ‘their Lordships in these respects’, adding ‘for full measure, deliberate malice’. Titmuss took particular exception to the ‘unwarranted and uninformed criticism of those who cannot answer back’ –​SBC staff. This was a ‘form of discrimination not covered by the Race Relations Board’. He then turned to Harvey’s article ‘which, as an old friend, I eagerly awaited’, but instead ‘fills me with sadness’. He could not take issue with her ‘many misconceptions and criticisms and errors’, but ‘on one fundamental matter she and others really must make up their minds’. Was the ‘concept of the family’ to be abolished not only in supplementary benefit, but also in national insurance and in common law? Should a man no longer have to maintain his wife, and any children under 16? If neither was the case, then,‘in the interests of justice and compassion’, there had to be a ‘cohabitation rule’. While this remained the law, the SBC had to enforce it. Consequently, what ‘then is important is how it is administered and the Commission is continually concerned to see that it is administered justly and sympathetically’. Finally, it was not true, and there was no evidence for the suggestion, that young mothers were having there allowances ‘whipped away’ in the manner claimed.50 The Lords debate on grants to students with dependants certainly captured Titmuss’s attention. He highlighted the passage in a report concerning the Labour peer Edith Summerskill.To award such benefits, Summerskill contended, ‘would lead to nice girls being exploited by awful young men’. The problem had arisen because SBC officials disliked paying students. These officials had ‘worse things to worry about –​after all, the chairs in their offices are sometimes nailed to the floor, to prevent enraged clients hurling them across the room. But I’m told they don’t like arguing with students: not only do they not work, but they tend to know their rights’.51 Apart from the flippant tone, what probably annoyed Titmuss especially was Summerskill’s previous

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role as a minister with welfare responsibilities. She should, therefore, have known better. Olive Stevenson, meanwhile, produced a book drawing on her SBC experience. The supplementary benefit scheme, as presently operated, undoubtedly had ‘many deficiencies’. Nonetheless, ‘even its most stringent critics’ agreed that it was ‘one of the best of its kind in the world’. She had seen nothing to suggest that the scheme’s present operations ‘were, in general, incompatible with the values of a civilised and humane society’. There was one possible exception, ‘the co-​habitation rule’. Titmuss saw Stevenson’s volume in draft, and, in her ‘Acknowledgements’, she particularly praised him as someone who had ‘helped me clarify my mind’.52 Titmuss had provided an 18-​ page critique, and some comments are revealing about his thoughts on the Commission by late 1971. For instance, Stevenson had apparently suggested that the SBC operated like a ‘policeman’. But,Titmuss pointed out, this was equally true of professions such as child care workers. There was a danger of increasing the stigma attached to the scheme ‘by allowing readers to think that only SB employs “police” methods’.Titmuss also addressed an issue about which he was increasingly concerned. It seems that Stevenson had stated, or implied, that ending the exercise of discretion by Commission staff would result in greater ‘egalitarianism’. Titmuss put the word in inverted commas in his comments, remarking that she might be right about what ‘militant social workers think but the consequences of abolishing all discretion in income maintenance could result in more inequality. It has in New York’.53 New York City’s social services were, as will already be evident, something of a bête noire for Titmuss, and his comments about criticisms of SBC officials as ‘policemen’ a recurring theme. The ‘co-​habitation’ rule caused considerable grief, with Titmuss’s daughter among its fervent critics.54 As Titmuss explained to Katharine Whitehorn, a journalist on The Observer, its object was ‘simply and solely to ensure that an unmarried couple who live together as man and wife do not get more favourable treatment than a married couple, which they would if they could claim as single persons … The rule is, therefore, a necessity’. Titmuss was responding to a piece Whitehorn had written, and made it clear that he was writing in a personal capacity. He agreed that the present ‘movement of opinion in society’ was unfair to women left on their own after marital breakdown. Nonetheless, her criticisms of the SBC’s approach was a ‘complete travesty’. Had she, for example, actually checked allegations made by the CPAG? Equally, why attack the SBC’s dealings with deserted wives when it was ‘by far the most effective way our society has yet designed for helping them?’

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The Commission’s approach was far ahead of similar schemes in North America, Australasia, and most of Europe.55 It is worth pursuing this correspondence, which stretched over the first six months of 1972, as it is revealing about Titmuss’s commitment to the SBC, and the complexities of policy implementation.Whitehorn replied to Titmuss’s original letter by suggesting that the Commission’s intentions were ‘not the whole story’. What happened at local level, on a day to day basis, ultimately depended ‘on the type and manner of people implementing those intentions’. It should be recognised, for instance, that claimants, already in distressing circumstances, might be ‘terrified of the officials’.56 Titmuss agreed that officials sometimes made mistakes and that, at local level, prejudices might play their part. Nonetheless, many staff performed well under considerable pressure. As a member of both the Commission and the Finer Committee, he had ‘yet to see any constructive alternative to our “Cohabitation Rule” ’. Many SBC critics wanted its abolition, but none had ‘yet made out a case for treating a married couple less favourably than single persons’. In a concluding passage, which suggests the pressure under which Titmuss was operating at this point, and his frustration with certain colleagues, he remarked that the time had come ‘for writers on the subject of “poverty spies” and “sex policemen” to be a little less parochial. Personally, I  exclude you from this category. But I am sure you will appreciate that I do have a need from time to time to explode!’57 A few weeks later, Whitehorn remarked that, since Titmuss’s last letter, cohabitation had received further newspaper coverage. She acknowledged he must be ‘heartily sick’ of the issue, but nonetheless had to respond, and started by agreeing that it was a ‘vast area for the staff to have to cope with’. But what ‘now intrigues me’ was the relationship between social workers and Commission officials.They were presently ‘wide apart’, and Whitehorn wondered whether ‘their roles could in any way be brought nearer’. She agreed, too, that there was probably no alternative to the cohabitation rule, but the ‘current agitation to allow women receiving benefit to go on receiving it pending appeal is surely a good idea’. Given that mistakes could be made, it was ‘entirely unclear to me how somebody about whom such a mistake has been made is to go on living if there is no money forthcoming at all’.58 Titmuss was, undoubtedly, ‘heartily sick’ of the matter, replying that ‘there are times when I too get bored with the subject of cohabitation’. Passing the buck somewhat, he concluded that it was ‘now one of the problems for the Finer Committee … which is expected to report towards the end of this year’.59

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There are numerous examples in his files of Titmuss taking exception to critical comments about the Commission, a sign of his sensitivity on the matter. So, for example, he highlighted passages in a critical review of the Handbook in the CPAG’s journal, where it was suggested that the former would increase the power of social workers over those whom they were supposed to be helping, that information would only go to the ‘respectable’, and that it had ‘viciously’ used the expression ‘voluntary unemployed’. Titmuss’s hand-​written comments summarised the article as ‘SBC dishonest, vicious’.60

Titmuss and Townsend Townsend was an SBC critic from the outset. In a speech in November 1966, he acknowledged that the newly formed body was trying to improve the image of discretionary benefits, and to ‘encourage more people to apply for supplementary help’. The chance to make a clean break with the ‘restrictive and narrow-​minded attitudes enshrined in the National Assistance Act of 1948’ had, though, been lost. On single mothers, the Commission had ‘powers to refuse benefit to a mother when it believes it has evidence of her living with a man. Anonymous letters are sometimes acted upon’.There were ‘individual officers who have responsibility for investigating fraudulent claims’, and some women had complained that officials had ‘searched rooms and cupboards without permission in attempts to check whether or not there are men present or are articles of men’s clothing lying around’. History’s likely verdict on the 1966 Act was, therefore, that it ‘achieved little more than extending national assistance, or supplementary benefit, to a larger number of the lower middle classes, while distinguishing rather more sharply between old and young’.61 Clearly,Titmuss and Townsend were going to approach the SBC from different positions. But although, as we shall see in Chapter 28, their relationship had cooled when Townsend moved to the University of Essex, they remained on reasonably good terms. However, matters took a turn for the worse in late 1968 when Townsend gave a speech to the Northern Ireland CPAG.This called for a ‘thorough and independent inquiry into the working of the present supplementary benefits scheme’. The SBC was ‘destined to follow the path of the old Poor Law’. It lacked the resources to improve the quality and quantity of staffing, lacked independence, and ‘hesitated to speak with moral authority’. Some families received benefits insufficient to lift them out of poverty, while others were the ‘victims’ of administrative practices disgraceful ‘to a country which cares passionately about justice’. It was not enough

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to await any new social security scheme from Crossman. Rather, no benefits should be stopped before claimants understood why this was taking place, or a tribunal had been held. Local information centres should be set up nationwide, ‘financed by public funds but independently staffed so that people knew exactly what their rights were’. Finally, the legal aid scheme should be strengthened.62 Titmuss told Townsend that he had ‘just seen a report in The Guardian in which you are quoted as saying that the Supplementary Benefits Commission is not independent and is destined to follow the path of the old poor law!’ He conceded that the press could misrepresent people –​‘I have suffered myself ’. So could he have a copy of Townsend’s speech?63 In his immediate reply, which included the CPAG press release for the Belfast meeting,Townsend took a conciliatory approach. He was ‘conscious that you will disagree with some of the attached’, but ‘would plead that in my role at CPAG I  am getting feed-​back from social workers all over the country which justifies great concern’. Townsend offered to ‘arrange a meeting at which some of the people who have represented appellants at Tribunal hearings could explain their experiences’.The press release, however, did indeed describe the SBC as ‘destined to follow the path of the old Poor Law’, as well as raising the points that Townsend had articulated in his speech.64 Townsend’s attempt to mollify Titmuss was not a great success. A few days later, Titmuss told Hayward that he was ‘so shocked by [Townsend’s] utter disregard for facts that I propose to reply’.65 Titmuss’s response ran to ten pages, beginning with an outline of the American situation, where the welfare ‘rights’ movement had created circumstances whereby clients were suffering, and caseworkers acquiring too much power. Presumably, Titmuss was seeking to tar Townsend with this particular brush. He then turned specifically to the press release, beginning with an acknowledgement of the SBC’s shortcomings. But improvements had been made. It was ‘absolutely untrue’ that the Commission could not work independently. Its powers were not ‘paper powers’. On Townsend’s argument for universal benefits, ‘you know my views on this issue’, particularly because he had publicly argued that the Commission’s aim should be to work itself out of a job. Meanwhile, it was necessary to await the anticipated White Paper. Titmuss saved his most powerful criticism for last. Townsend had called for a ‘thorough and independent enquiry’ into ‘our present practices’. This was being ‘taken everywhere’ as a ‘direct attack on the integrity and competence’ of all Commission members, and of staff at all levels. They were hence being accused of ‘sinister practices and of disregarding human rights’. Civil servants could not answer back,

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but ‘I at least am in the position to do so and felt, quite voluntarily, that I should write though I have found it very painful indeed to say such things to an old friend’. Titmuss’s ‘chief reason’ for so doing was because ‘I am concerned about our relations with people’. He then described a local office manager who ran seminars at which staff discussed ‘questions of tone of voice, mode of address, memory and the civilities’, all of ‘paramount importance in our work’. Did Townsend think ‘that he and others are encouraged to go on with such seminars when they are publicly attacked for disregarding human rights?’66 The CPAG press release, and notes of Titmuss’s response to Townsend, were then circulated among SBC members and senior DHSS officials.67

Defending the SBC: universal or selective? Titmuss’s dispute with Townsend raised a number of important issues about how welfare policy should develop, so we now move on to the third theme identified earlier, his attempt to reconcile universalism with selection and discretion.Titmuss was prepared to defend the policy of discretion in public and in private. As we saw in Chapter 23, he had raised the issue in his 1966 Chicago speech.Two years later, following a piece in Nursing Mirror, he told one of its readers that providing there was a ‘comprehensive and universal structure of social security “as of right” I believe it is possible to build in selective benefits with a minimum of stigma’.68 Titmuss also appeared on radio to explain his views, giving a talk in autumn 1969 on ‘selectivity for need within the infrastructure of universality’ on a programme entitled ‘Poverty Today’.69 What, then, was Titmuss arguing? In two important articles, he articulated further his philosophy of welfare. The first, ‘Universal or Selective? The Practical Case Against the Means-​Test State’, appeared in New Statesman in 1967, with Titmuss only a few months into his commissioner’s role. By his own admission, it was not ‘easy reading’ because of the complexities involved. It is difficult to disagree.The piece was underpinned by two fundamental principles. First, socialist social policies were ‘totally different in their purposes, philosophy and attitudes to people’ than those of the Conservatives. They were, or should be, ‘pre-​eminently about equality, freedom and social integration’. Second, there could be ‘no answer in Britain to the problems of poverty, ethnic integration, and social and educational inequalities without an infrastructure of universalist services’. The question was: how to achieve these goals? Titmuss dismissed ‘computer solutions’, and those of the ‘theoreticians’, in any attempt to resolve the apparent dichotomy between selective and universal services. Computer solutions, by

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which he meant a hyper-​rationalised system wherein all aspects of an individual’s benefit claim could in some way be codified, could not work because, apart from anything else,‘there are fundamental issues of moral values and equity which, in the wider interests of society, must be taken into account in the scope, content, characteristics and frequency of means-​tests and in charges for service and benefits’. Computers could not solve ‘the problems which human beings have not yet adequately diagnosed’.The ‘computer solution’ had, unfortunately,‘muddled quite a lot of well-​meaning people’, but if implemented would create an ‘administrative nightmare’.70 Such remedies were, though, proving attractive to ‘theoreticians’, among whom Titmuss counted the Conservative Party’s Bow Group. Their advocacy of computer solutions to enable selectivity were not only ideological (although Titmuss did not spell this out), however, but also based on a profound misunderstanding of the world of benefit claimants. What, then, was the ‘practical’ case against (as opposed to theoretical case for) means tests? Again, the issue was more complex than such a simple dichotomy would suggest. But what was unacceptable was a form of selectivity requiring ‘some inquiry into resources to identify poor people’ when the latter, in fact, ought to be provided with ‘free services or cash benefits, be excused charges, or pay lower charges’, which would have the additional benefit of furthering income redistribution.71 There were, though, more positive aspects to selectivity.To be sure, it should not be used to stigmatise the poor or to contribute to further social segregation (or, as in America, racial segregation).The answer to contemporary social problems was not to create ‘separate, apartheid-​ like structures and “public burden” services for poor people’. It had to be recognised that, and here both the ‘theoreticians’ and ‘welfare rights’ activists were the targets, ‘there were no standard families with standard or uniform requirements and resources’. If equity, ‘one of the touchstones of a civilised society’, was to be achieved,‘then the content, scope, characteristics and frequency of means-​tests and charges must differ according to the type of service to be provided’. Hence, within a system of universal ‘rights’, discretion or selectivity could be used not to disadvantage the poor, but to allow the system to work in their interests. The ‘real challenge’, therefore, lay in creating an ‘infrastructure of universalist services’ so as to provide a ‘framework of values and opportunity bases within and around which can be developed acceptable selective services’.The latter should be provided on a ‘social rights’ basis, structured around the needs of particular categories of claimants, rather than individual means tests. It was in such ‘practical ways’, which

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avoided ‘an assault on human dignity, which are not socially divisive, and which do not lead to the development of two standards of services for two nations’, that further redistribution could be brought about for ‘those whose needs are greatest’.72 Titmuss’s article provoked Labour MP Lena Jeger to offer her congratulations ‘on your magnificent piece in the New Statesman’, with the ensuing critical letters being, in her view, ‘so feeble’.73 Following correspondence in early 1968, meanwhile, Geoffrey Howe confirmed that ‘we are greatly looking forward to your taking part in the “Teach In” on Monday’.74 Howe chaired the Social Services Standing Committee of the Bow Group, the Conservative body Titmuss had criticised in his article. Following the meeting, Norman Lamont, like Howe a future Chancellor, thanked Titmuss ‘most sincerely’ for his contribution. Those present ‘appreciated your controversial talk which certainly brought the evening alive’, while some were ‘more than a little dismayed by some of the administrative problems which you described!’75 Although it was nowhere made explicit, the New Statesman piece was undoubtedly behind this invitation. The second article, published in 1971, was based on a lecture given to DHSS summer school in 1970. It, too, had an illuminating title, ‘Welfare “Rights”, Law and Discretion’.The inverted commas around ‘rights’ are as deliberate as those Titmuss employed around ‘welfare state’.The merger of non-​means-​tested and means-​tested benefits in 1966 had highlighted ‘fundamental issues of precedence or innovation, precision or flexibility, rule or discretion, equity or adequacy in regard to social security’.Titmuss sought to address one particular issue: ‘the choice between legal rule and administrative discretion’. In Western societies there had been a ‘libertarian explosion’, with more individuals and groups claiming their ‘rights’. Exponents of ‘welfare rights’ argued against ‘the use of discretion’ on the basis that this gave too much power to the ‘so-​called bureaucrat of the public welfare system’.To be preferred, from this standpoint, were the clarity and equity of legally based rights. Titmuss was having none of this. The ‘belief that lawyer’s law contains no element of discretion’ was ‘completely false’, while there existed a ‘quaint belief in the mechanistic objectivity of lawyer’s law’.Titmuss provided a raft of authorities backing his objections to the ‘pathology of legalism’, defined as ‘an insistence on legal rules based on precedent and responsive only very slowly to rapidly changing human needs and circumstances’. The notion that claimants’ rights would be ‘grossly restricted’ were they not represented by lawyers, as argued by the likes of the CPAG, was thus dismissed.76

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Titmuss agreed that people should know their rights, and the Commission’s Handbook was a step in the right direction. As to discretion, this had various benefits, not least that it preserved the ‘dignity of the individual recipient of supplementary benefit by allowing him some choice in how his income is expended’. Discretion allowed, too, for flexibility, and if claimants felt aggrieved about how they had been treated, appeals tribunals were available. In fact, and what was ‘insufficiently recognised’, was that the supplementary benefit scheme provided ‘fully legalised basic rights’, while simultaneously allowing for ‘additional grants which allow flexible responses to human needs and to an immense variety of complex individual circumstances’. More detail about various aspects of the scheme followed, including Titmuss’s recurrent complaint about the physical conditions which staff and claimants alike suffered. His concluding sentences went to the heart of his late approach to welfare. He believed, ‘because I do not wish to see poorer people stigmatised as poor people’, that it was possible to ‘develop a system of flexible, individualised justice based on considerations of dignity and self-​respect’. But this could not happen ‘with millions of clients and inadequate resources in manpower’. And, with a final, if somewhat cryptic, knockout blow, it would do no good ‘to call in the lawyer –​even if, by the year 2000, he was marginally interested’.77

Conclusion In 1968 Arthur Seldon launched one of his periodic attacks on Titmuss and his colleagues. The ‘high priests of universalism’ –​Titmuss, Abel-​ Smith, and Townsend  –​persisted with their ‘intellectual rearguard action in defence of an outworn, inhumane, profligate principle’. Reassuringly, it seemed that ‘fewer listen to them’, and they had little to ‘offer supposed beneficiaries of state welfare but stringency, injustice, and chains’.These ‘high priests’ obstinately refused to ‘see that the more poverty they uncover the more irrelevant universalism becomes.They have no escape from their dilemma’.78 Seldon was either mischief-​ making, or genuinely unaware of Titmuss’s shifting, intellectually flexible, position.The latter’s defence of the SBC, his attempt to reconcile universalism and discretion, and his rejection of welfare ‘rights’ caused a breach with colleagues, notably Townsend. As to his stated desire that the SBC would be successful if it reduced discretionary benefits and did itself out of a job, this was to be a forlorn hope. Means-​tested benefits constituted 42 per cent of total spending on cash benefits when national assistance was introduced in 1948. This had fallen to 26 per cent by 1965, just before the SBC came into being. But the proportion

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then rose inexorably, with the expansion of means testing since the 1960s leading to ever more complex administrative arrangements.79 Notes 1 H. Glennerster, obituary of David Donnison, The Guardian, 30 May 2018, p 8. 2 R. Crossman, The Diaries of a Cabinet Minister: Vol II, Lord President of the Council and Leader of the House of Commons, 1966–​68, London, Hamish Hamilton/​Jonathan Cape, 1976, entry for 23 November 1966. 3 R. Crossman, Socialism and Planning: Fabian Tract 375, London,The Fabian Society, 1966, pp 1, 5. 4 P. Jenkins, ‘Cabinet Seeks £120m Cuts in Public Spending Next Year’, The Guardian, 25 November 1966, p 6. 5 G. Moorhouse, ‘The Poverty Lobby’, The Guardian, 3 December 1966, p 7. 6 Crossman, The Diaries of a Cabinet Minister: Vol II, entry for 16 January 1967. 7 ‘Doubling Family Allowance “No Root Cure” ’, and D. Marquand, ‘Settling the Battle Lines’, The Guardian, 17 January 1967 pp 3, 14A. 8 TITMUSS/​4/​640, letters, 10 January 1967, Herbison to RMT, and 12 January 1967, RMT to Herbison. 9 TITMUSS/​4/​640, letter, 14 May 1968, Hart to RMT. 10 TITMUSS/​4/​640, letters, 6 September 1971, RMT to Joseph, and 24 September, Joseph to RMT. 11 TITMUSS/​4/​640, letter, 20 January 1967, Caine to RMT. 12 LSE/​Staff Files/​Titmuss, memorandum, 17 January 1967, Caine to LSE Standing Committee. 13 J. Tomes, ‘Sir Richard Arthur Hayward’, Oxford Dictionary of National Biography, Oxford, Oxford University Press, 2004. 14 TITMUSS/​4/​640, letter, 16 May 1968, Hayward to RMT. 15 Report of the Ministry of Social Security for the Year 1967: Cmnd 3693: Report by the Supplementary Benefits Commission, London, HMSO, 1968, pp 22, 23, 24–​5. 16 Supplementary Benefits Commission, Supplementary Benefits Handbook, London, HMSO, 1970, p 1. 17 TITMUSS/​7/​40, letter, 8 May 1968, Crossman to RMT. 18 R. Crossman, The Diaries of a Cabinet Minister: Vol. III, entry for 8 May 1968. 19 A. Cairncross, The Wilson Years: A Treasury Diary, London, The Historians’ Press, 1997, pp 315–​16, entry for 30 July 1968. 20 R.M.Titmuss, letter, New Statesman, 12 December, 1969, p 864.The contentious headline was published on 5 December 1969; the pamphlet referred to is R.H. Crossman, Paying for the Social Services:  Fabian Tract 399, London, The Fabian Society, 1969. 21 D. Reisman, Richard Titmuss: Welfare and Society, Basingstoke, Palgrave, 2nd edn 2001, pp 24, 153–​5. 22 TITMUSS/​4/​640, letter, 27 August 1968, RMT to A.J.G. Crocker. 23 R.M. Titmuss, ‘New Guardians of the Poor in Britain’, in S. Jenkins (ed), Social Security in International Perspective: Essays in Honor of Eveline M. Burns, New York, Columbia University Press, 1969, pp 151, 153, 157–​9, 168, 161, 163, 164. 24 Ibid, pp 165, 166, 167, 168, 169. 25 TITMUSS/​7/​75, letters, 7 August 1967, Lynes to RMT, and 5 December 1967, David Fairbanks, London Co-​Operative Education Department, to RMT.

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The Labour government, social policy, and the Supplementary Benefits Commission 26 Titmuss, ‘The Right to Social Security’, pp 8, 9 (emphasis added), 27 TITMUSS/​4/​568, cutting from New Society, K. Fitzherbert, ‘Groomed to Give’, 22 July 1971. 28 TITMUSS/​4/​568, undated notes ‘Dealing with People’. 29 Report of the Ministry of Social Security for the Year 1967, p 23. 30 TITMUSS/​4/​640, letter, 29 November 1968, RMT to Halsey. 31 TITMUSS/​4/​566, letter, 10 June 1969, RMT to Hayward. 32 TITMUSS/​4/​640, letter, 6 September 1971, RMT to Joseph. 33 TITMUSS/​4/​640, letter, 24 September 1971, Joseph to RMT. 34 TITMUSS/​3/​370, typescript ‘The Evolution of Social Policy’, talk to be given at the Civil Service College, 23 November 1970, pp 1–​2. 35 TITMUSS/​4/​566, letter, 4 June 1971, R.M. Morris, Civil Service College, to RMT. 36 TITMUSS/​4/​565, RMT,‘Supplementary Benefits Commission: Note on a visit to Hinchley Wood –​19th June 1972’. 37 A. Lester, Democracy and Individual Rights: Fabian Tract 390, London, The Fabian Society, 1969, pp 9–​10. 38 TITMUSS/​4/​564, letters, 7 February 1969, RMT to Hayward, and 10 March 1969, Custance to RMT. 39 TITMUSS/​4/​564, letter, 14 March 1969, RMT to Lester (emphases in the original). 40 TITMUSS/​4/​564, letter, 1 May 1969, Lester to RMT. 41 TITMUSS/​4/​564, letter, 22 May 1969, RMT to Lester. 42 TITMUSS/​2/​208, letter, 23 January 1970, Field to RMT and others. 43 Letter, F. Field and others, ‘The Case for Budget Action on Family Allowances’, The Times, 2 March 1970, p 11. 44 TITMUSS/​2/​208, cutting from The Sunday Times, 22 March 1970. 45 TITMUSS/​2/​214, letter, 31 March 1970, Field to RMT. 46 TITMUSS/​2/​214, ‘Note of a talk with FRANK FIELD –​9th April 1970’. 47 TITMUSS/​2/​208, letters, 25 March 1970, 29 March 1970, and 9 April 1970, RMT to Editor, The Sunday Times. 48 TITMUSS/​2/​208, letter, 7 April 1970, Rosaline Brooke, LSE, to RMT. 49 A. Harvey, ‘Handbook to Poverty’, New Statesman, 8 May 1970, p 650. 50 TITMUSS/​4/​563, undated (but spring 1970) letter, RMT to the Editor, New Statesman (emphasis in the original). 51 TITMUSS/​2/​208, cutting from New Statesman, 8 May 1970, highlighted by RMT. 52 O. Stevenson, Claimant or Client? A Social Worker’s View of the Supplementary Benefits Commission, London, George Allen and Unwin, 1973, pp 10, 7. 53 TITMUSS/​4/​567, letter, 23 December 1971, RMT to Stevenson, and attached eighteen page commentary, references at pp 5, 7 (emphasis in the original). 54 Oakley, Father and Daughter, pp 180–​1. 55 TITMUSS/​4/​565, letter, 24 January 1972, RMT to Whitehorn. 56 TITMUSS/​4/​565, letter, 29 March 1972, Whitehorn to RMT. 57 TITMUSS/​4/​565, letter, 28 April 1972, RMT to Whitehorn (emphasis in the original). 58 TITMUSS/​4/​563, letter, 1 June 1972, Whitehorn to RMT. 59 TITMUSS/​4/​563, letter, 16 June 1972, RMT to Whitehorn. 60 TITMUSS/​4/​564, copy of Poverty, 15, June 1970 with comments by RMT. 61 P.Townsend, Poverty, Socialism, and Labour in Power, London, Fabian Society, 1967, pp 22, 6, 23.

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RICHARD TITMUSS 62 ‘ “Need for Shake-​Up” in Benefit Aid’, The Guardian, 9 November 1968, p 7. 63 TITMUSS/​8/​13, letter, 11 November 1968, RMT to Townsend. 64 TITMUSS/​8/​13, letter, 12 November 1968, Townsend to RMT with CPAG press release, 9 November 1968, attached. 65 TITMUSS/​8/​13, letter, 14 November 1968, RMT to Hayward. 66 TITMUSS/​8/​13, letter, 17 November 1968, RMT to Townsend, pp 1–​2, 2–​4, 9–​10 (emphasis in the original). 67 TITMUSS/​8/​13, memo and attachments, 23 December 1968, D.G. Beard, Supplementary Benefits Commission to various SBC members and DHSS civil servants. 68 TITMUSS/​7/​76, letter, 10 April 1968, RMT to Miss B. Allen. 69 TITMUSS/​7/​77, letter, 13 September 1969, Hugh Purcell, Producer, Further Education (Radio), BBC, to RMT. 70 R.M.Titmuss,‘Universal or Selective? The Practical Case against the Means-​Test State’, New Statesman, 15 September 1967, pp 308–​10. Reprinted as ‘Universal and Selective Social Services’ in Commitment to Welfare. 71 Titmuss, ‘Universal or Selective?’, pp 308–​10. 72 Ibid, pp 308–​10. 73 TITMUSS/​7/​75, letter, 27 September 1967, Jeger to RMT. 74 TITMUSS/​7/​76, letter, 15 March 1968, Howe to RMT. 75 TITMUSS/​7/​76, letter, 24 March 1968, Lamont to RMT. 76 R.M. Titmuss, ‘Welfare “Rights”, Law and Discretion’, Political Quarterly, 42, 2, 1971, pp 113, 114ff, 118–​20, 124–​5. 77 Ibid, pp 126, 127, 130, 132. 78 A. Seldon, After the NHS: Reflections on the Development of Private Health Insurance in Britain in the 1970s, London, IEA, 1968, p 41. 79 P. Johnson, ‘The Welfare State, Income and Living Standards’, in R. Floud and P.  Johnson (eds), The Cambridge Economic History of Modern Britain:  Vol III, Structural Change and Growth, 1939–​2000, Cambridge, Cambridge University Press, 2004, p 221.

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26 A public figure in troubled times: Vietnam, race relations, and the Common Market Introduction Although he may have objected to the description, by the 1960s Titmuss was, undoubtedly, one of the ‘great and the good’, a public intellectual constantly called upon to sign petitions, join committees, and offer an opinion on a range of issues. In 1962, for instance, he was a signatory to a telegram to the chairman of the Council of Ministers in Budapest. British scholars and scientists, it stated, were ‘grieved by news of the failing health of eminent legal historian István Bibó’. Bibó, a prominent member of the Hungarian government which had briefly defied the Soviet Union, had been imprisoned in 1957. His early release, the cable continued, would contribute to the establishment of friendly links between Hungarian and Western intellectuals. Other signatories included A.J. Ayer, Julian Huxley, and Bertrand Russell.1 Sent at the height of the Cold War, this intervention was part of a broader campaign to secure the rights of ‘prisoners of conscience’. In spring 1964, meanwhile,Titmuss was approached by George Martin (a drama teacher, not the producer of the Beatles) to join the General Council of the proposed International Centre in Covent Garden.The aim was to use the site, soon to be vacated by the historic fruit and vegetable market, for conference, artistic, and scientific purposes.Titmuss agreed, and produced a paragraph for a proposed report which read: ‘London deserves an International Centre in the Covent Garden area on the lines proposed. London needs these facilities for education and relaxation in a planned environment of public gardens. It is the only civilized response if London is still to be London’.2 Titmuss’s commitment to

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London, his home and place of employment since late childhood, is apparent here. As he told an official committee in 1963, he knew of no profession, including his own, which did not want to work in the capital. The presence of four television companies, moreover, further broadened opportunities for those such as himself.3 This chapter focuses on Titmuss’s response to three great issues of the 1960s and 1970s –​the Vietnam War, race relations, and Britain’s stumbling attempts to join the European Union’s predecessor, the European Economic Community (the EEC, generally referred to as the Common Market).As always, these activities need to be seen in the context of his other, numerous, commitments. Membership of the ‘great and good’, or the ‘Establishment’, was, though, a cause of concern for certain colleagues. The notion of the ‘Establishment’, first mooted in the 1950s, referred to those in British life wielding, or close to, power, be it cultural, political, or whatever.

Vietnam America’s escalating war in Vietnam was the cause of concern, especially to the liberal left. For the post-​1964 Labour governments it was notably problematic in that Prime Minister Wilson was conscious of Britain’s existing commitments to American foreign policy, while aware of the hostility this provoked among party members.These opponents were not drawn solely from Labour’s left wing, with ‘moderates’, and Titmuss’s friends, such as Shirley Williams and Peter Shore, increasingly critical of American behaviour. By early 1965, public opinion more broadly disapproved of US intervention. As Sylvia Ellis shows, disillusionment with the Labour government led ‘Left-​leaning students, middle-​class activists, intellectuals and trade unionists’ to seek ‘avenues of extra-​parliamentary protest’.This was most obviously manifested in the large-​scale demonstrations which took place, especially in 1968. But other forms of protest occurred too, with the first British ‘teach-​ in’ about the war held at the LSE in June 1965. Speakers at this event included Ralph Miliband, a political scientist at the School.4 Titmuss was, as we have seen, sceptical about President Johnson’s ‘War on Poverty’. But he was equally sceptical about Johnson’s actions in Vietnam. In late 1965, the actor Vanessa Redgrave sought Titmuss’s support for a letter about the current situation which she and the journalist James Cameron were drafting.5 After further amendment, this appeared in The Times on 23 December as a whole-​page advertisement, paid for by the signatories and their supporters, protesting against America’s escalation of the war. Among their fears was that the

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‘Government of the United States of America may now be determined upon a solely military solution in VietNam’. The 38 who signed certainly included a number who could be seen as situated at, and vocally active around, various points on a left-​wing spectrum, including the New Statesman editor Paul Johnson, and Titmuss. Others, though, could not be so placed, for instance the artists Graham Sutherland, and Barbara Hepworth.6 This was, then, the ‘great and the good’ expressing their views through that most ‘Establishment’ of newspapers, The Times. Such action was thus at some remove from the physical confrontations between anti-​war protestors and the police. The advertisement provoked two interesting responses. First,Titmuss, like all his co-​signers, received a letter from Philip Kaiser, US chargé d’affaires in London. This noted that Titmuss, one of a ‘group of distinguished signatories’, had called in the advertisement for the US government to ‘take certain specific actions in regard to the situation in Vietnam’. It was thus important that the administration’s policy be made clear. Accordingly, each signatory was being sent an ‘authoritative background statement of this policy by a high level US official’.7 This was surely a sign of how seriously American officialdom took the advertisement, and the standing of its authors. Public opinion played an important role in the Vietnam War, the first conflict to receive extensive television coverage. Given that Johnson was still hopeful of active British support, it was, presumably, thought vital to engage with critical, and influential, opinion. The second response appears, at first glance, unrelated. On the day the advertisement was published in The Times, Titmuss, again like all other 38 signatories, received a telegram from the editor of the British news magazine Time and Tide, asking whether he supported the use of force in Rhodesia.8 As discussed further below, the white settlers in Rhodesia had recently unilaterally declared independence. Titmuss did not reply to this question, and so was listed as among the 17 non-​respondents to the journal’s enquiry. In the magazine’s headline he was thus one of ‘The 17 men who advertise their “alarm” over war in Vietnam but stay silent on the use of force in Rhodesia’.9 Given that signatories such as Titmuss were from the liberal left, and hostile to the Rhodesian regime, possibly to the point of supporting military intervention, the implication here is that the non-​respondents were at best equivocating, at worst hypocrites. In July 1966, meanwhile, Titmuss and David Glass sent a letter to The Times condemning what they saw as Wilson’s opaque approach to the war. This was, in fact, turned down on the grounds that groups of staff from other universities had already written in a similar vein.10 These included, for example, a distinguished group from the University

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of Cambridge which had applauded Wilson for condemning recent bombing attacks on North Vietnam but, nonetheless, ‘deplored the inconsistency of [Wilson’s] support for other United States activities in Vietnam’.11 The commonality of phrasing seems to suggest that this was a coordinated response by university staff across Britain in which Glass and Titmuss participated. Rejection notwithstanding, we can again see here Titmuss’s concerns about the conflict, and his willingness to make his position public. He would have been well aware, too, of the divisions in America itself over Vietnam, given his frequent visits to the country, and his engagement with colleagues there, most of whom were likewise politically on the liberal left. It is also ironic that part of the motivation of the student and staff protestors during ‘The Troubles’ at the LSE was opposition to the Vietnam War. Titmuss, as we shall see in Chapter 28, while sharing the protestors’ views about Vietnam, was hostile to what he saw as their disruptive activities at the School.

Race relations In Chapter 15 we encountered Titmuss’s 1962 speech to the WEA, one of a number expanding upon The Irresponsible Society. This particular address broached new territory with respect to race relations and, as we shall see, EEC membership.To take the first of these, discussing the position of ‘minority groups’Titmuss singled out the treatment of the ‘coloured population’, and recent racially discriminatory legislation. Whatever the Labour opposition’s shortcomings, it was to its credit, and that of its leader, ‘that it wholeheartedly opposed this measure’.12 This was a reference to the 1962 Commonwealth Immigrants Act which sought to restrict the inflow of potential migrants, and was partly a response to growing racial tensions as manifested by the 1958 Notting Hill riots. The Act had been flagged up at the previous year’s Conservative Party conference, prompting Titmuss to write to The Times that the proposal could ‘hardly be regarded as an act of faith in the future and of confidence in the ideals of the Commonwealth’.13 And Gaitskell had, as Titmuss observed, opposed the legislation during its parliamentary passage, accusing the government of yielding to the ‘crudest clamour’, and more generally denouncing ‘this miserable, shameful, shabby bill’.14 Titmuss was an opponent of racial discrimination, and prepared to speak out against it. He was aware, too, of the difficulties caused by racial tension in the USA, and of the problems of integrating immigrants in Israel. He, like many others, no doubt hoped that with the return of a Labour government in 1964, at least at official level this would

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be less of an issue in Britain. But Titmuss was not complacent. In a 1965 interview with the left-​wing journal Tribune, he suggested that the Conservative opposition’s proposals for more selective welfare benefits would increase discrimination against immigrants, and ‘coloured people’.This was because if tests based on need were introduced, ‘it is going to be the immigrants who will in large numbers have to go through these tests and be exposed to the consequent enquiries’. While, in principle, such tests would apply to all claimants, in practice they would especially impact on immigrants, and would thus be ‘bound to be seen as one more measure of discrimination’.There was a ‘direct relation between policy for the social services and the integration of immigrants’.This was, therefore, ‘one of the most powerful arguments in favour of continuing and expanding social services which are universal and cover everyone without qualification’.15 On the international front, meanwhile, the Labour government faced the problem of the Unilateral Declaration of Independence announced, in late 1965, by the government of the British Southern African territory of Rhodesia. This was an illegal move by the white settlers to pre-​empt African majority rule, as had been tentatively proposed by the British. The British government took a number of immediate measures, but not enough for some. Crossman recorded in November that Wilson, and other ministers concerned, were taking ‘the most appallingly orthodox, narrow-​minded view of how we must now behave’. Crossman himself was not averse to military action.16 The Anti-​Apartheid Movement, originally set up to challenge the regime in South Africa, mobilised against the rebels, issuing a ‘Declaration on Rhodesia’ in June 1966, with Titmuss among the signatories.This called on the government to ‘make immediate preparations for establishing a free and independent Rhodesia based on majority rule’ while securing as quickly as possible the support of, and enforcement by, the United Nations Security Council for compulsory economic sanctions on Rhodesia worldwide.17 Back on the domestic front, in early 1965 Titmuss was contacted by Anthony Lester, the human rights lawyer encountered in the previous chapter as a critic of the SBC. He told Titmuss that there had been positive additions to the Race Relations Bill (soon to be Act), and he was now writing about the possible creation of a ‘press centre on race relations’. The two had discussed this over dinner at Titmuss’s house, and Lester wanted Titmuss to be a sponsor of the proposal.18 The issue of ‘race’ had featured in the 1964 general election, poisonously so in certain parts of the country.The 1965 Race Relations Act was the first piece of British legislation to outlaw racial discrimination, as well as

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setting up the Race Relations Board. Titmuss soon had the chance to influence government, and party, policy following his adoption as a member of Labour’s working group on Commonwealth immigration in early 1966.19 The issue was, however, to be far from straightforward. In 1965, the National Committee for Commonwealth Immigrants was set up with government backing. Headed by the Archbishop of Canterbury, Michael Ramsay, its brief was to ‘promote and coordinate on a national basis efforts directed towards the integration of Commonwealth immigrants into the community’.Titmuss joined this body.20 Oakley suggests that it was only when Titmuss realised that Ramsay was to be chair that he agreed to join the Committee. Adrian Sinfield recalls being told more than once by Townsend that, in his view,Titmuss’s membership of this organisation marked a shift in his broader social thought. While it is not entirely clear what Townsend meant by this, it is possible that he saw Titmuss being embraced by the ‘Establishment’. If so, Townsend’s suspicions would have been confirmed, shortly afterwards, by Titmuss’s acceptance of a CBE. Oakley certainly feels that her father was, by the late 1960s, ‘decisively … an establishment figure’, and that this was an important contribution to his declining relationship with Townsend.21 The setting up of the Committee might nonetheless be seen as a positive move. But it was not sanguine about British race relations, or about its own powers. Its 1967 report, for example, noted the frustrations of ‘trying to tackle a deteriorating situation by voluntary and persuasive means alone’. It was also critical of existing legislation, with the 1965 Act doing nothing more than ‘scratch the surface’. Its own role was as an independent body outside official control but, nonetheless, with ‘close links’ to the government –​‘in certain cases directly with the Prime Minister and in others with the Home Secretary’.22 Just how close these links were will presently become apparent. Titmuss’s contribution to the Committee included membership of two advisory boards. The first was in support of an investigation by Political and Economic Planning into racial discrimination.23 The second monitored the work of the Street Committee, charged with looking at anti-​discrimination legislation. This body consisted of three lawyers, one of whom was Titmuss’s old sparring partner, the Conservative Party’s Geoffrey Howe. 24 Both reports were commissioned partly by the National Committee in the lead-​up to the expected amendments to the Race Relations Act. It is also notable that the National Committee submitted, in conjunction with the Institute of Race Relations, evidence to the Seebohm Committee with which, as we have seen, Titmuss was involved. This submission remarked that

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while Seebohm’s terms of reference did not directly refer to immigrants, nonetheless how local authority services were organised and run was of considerable importance to them.Among the points made were that the ‘concept of special services designed specifically for immigrants is an unsatisfactory one, in that it diverts attention from consideration of the long-​term imperatives of the situation by encouraging a false evaluation of the situation’.25 It is difficult to know who wrote this, but it does have a Titmuss ring to it. We also know that, by this point, Titmuss was well aware, from the experience of the United States, that even well-​intentioned social policies could exacerbate discrimination and segregation. The National Committee was to be succeeded by a statutory body, the Community Relations Commission, created in late 1968 under the terms of that year’s Race Relations Act. It was chaired by the prominent ex-​trades union leader, and former Labour Minister, Frank Cousins. Titmuss joined this body too.26 As an early publicity flyer for the new Commission put it, its task was to ‘break down prejudice and intolerance through public education and information, and through positive measures to encourage co-​operation between different ethnic groups within the community’.27 In addition to setting up the Commission, the 1968 Act extended the powers of the Race Relations Board. So far, so positive. But even before the Commission’s formal creation, progressives such as Titmuss were aghast at the government’s proposal to limit Commonwealth immigration on, effectively, racial grounds. This was a panic response to events in Kenya which suggested that, in the near future, a large number of Asian Commonwealth citizens would seek entry to Britain. Titmuss was thus one of the signatories to a letter, published in The Times in late February 1968, headed ‘The Turning Point’. ‘For the first time’, it commenced, ‘racism is to be written into British law’. Not pulling its punches, the letter suggested that ‘appeasement of racists apparently means more than the honour of the British Government or the rights of British citizens’. All the signatories had, in the past,‘voted and worked for the Labour Party’. But the proposed legislation was ‘the turning point. We cannot see ourselves voting for a party that goes through with this policy’.28 A few days later, though, the Commonwealth Immigrants Bill received Royal Assent. On the day this took place, Tribune, in a front-​page article entitled ‘Racialist Law for Britain’, noted that Titmuss and Townsend, ‘two of the architects of Labour’s plans for social security’, had signed the letter to The Times.‘Many more’, the piece continued,‘will be following them out of the party in sheer disgust’.29 Also in early March, Labour MP Frank Judd commended Titmuss on ‘your brave stand along with others

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on the Commonwealth Immigration Bill’.The issue was ‘symptomatic of more serious problems’. At the last two general elections, ‘it was quite clear that articulate leaders of progressive opinion were on the whole in support of the Labour Party’.This was now less true, and Judd urged Titmuss, and those of like mind, to arrange, as soon as possible, ‘a relaxed and informal meeting at which you and active politicians should assess exactly what has gone wrong’.The party’s leadership was ‘necessarily concerned with bulk votes if we are to win the election’. While large numbers of ‘the less enlightened sections of the electorate do not altogether understand the views of progressive thinkers’, nonetheless they could ‘sense whether the party has such thinkers or not’. The current ‘drifting apart detracts from our visibility’.30 Titmuss told Judd that a ‘group of us are meeting next week to think about the future’, and that he would subsequently get in touch. In the meantime, he was ‘still very busy with the National Committee in doing what we can to repair some of the damage’.31 Titmuss’s predicament was known beyond Britain. From Israel, his friend Israel Katz wrote that the news from England was ‘very discouraging indeed, especially for people like me who have been trying to point to the Labour government as a model from which we should learn’. It had been rumoured that ‘you are giving serious thought to resigning from the Labour Party. Is that true?’32 In the hectic first few days of March 1968,Titmuss sought a meeting with Crossman, who recorded how ‘deeply touched’ he was that Titmuss wanted to ‘make it clear that he hadn’t broken with the Labour Party as had been stated in the press’. By Crossman’s account,Titmuss claimed that ‘I had to make all those statements about the Kenya Asian Bill in order to keep the coloured members of the Archbishop’s Advisory Committee from resigning’. Titmuss acknowledged that ‘no real racialism had been displayed by the Cabinet’. Rather, Home Secretary James Callaghan had been ‘extraordinarily incompetent’, and it was ‘inconceivable’ that he should have gone ahead ‘without consulting the National Committee’.Titmuss reassured Crossman that he still wanted to help him, and in return Crossman assisted Titmuss in drafting a memo to Wilson stating the Committee’s position on key issues.33 On the same day, 8 March, Tribune published a jointly authored letter from Titmuss and Townsend. They had no intention of quitting the Labour Party. But they were critical of government policy over the Kenyan Asians, and if these did not change ‘our allegiance will be in question’. In the end, though, ‘we would do what we can to influence discussion about social policy within the Labour movement’.34

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In any event, Titmuss was part of a small delegation from the National Committee which had a 90-​minute meeting with Wilson and Callaghan. Committee members reportedly made ‘no attempt to mask their disgust’ with the recent Act, seeking assurances that the Race Relations Bill would be ‘strong and effective’. While no resignations were offered by its members, it was felt the Committee’s future would depend on Wilson’s response to their demands.35 Presumably assurances were given since Titmuss retained his membership of the Committee, before joining its successor. And, in any event, he had signalled to Crossman his wish for the Committee to carry on, and to remain a member of it. Titmuss does not come out of this particularly well. To be a signatory to a letter one day and then equivocate about it shortly afterwards smacks of political manoeuvring, particularly given the rather lame rationale he put forward for his behaviour. Having said that, there can be no doubting his commitment to the anti-​discrimination cause. The stakes were significantly raised when another of Titmuss’s old adversaries, Enoch Powell, made his infamous ‘rivers of blood’ speech of April 1968 in which he predicted race riots like those presently tearing the US apart. Equally disturbing, in his view, were the implications for the balance of the population if large-​scale immigration continued. Powell’s views proved depressingly popular with the British public, and he made a series of speeches further elaborating them. One immediate response by Titmuss was his participation in a ‘Teach In on Race Relations’ at the LSE Students’ Union, an event almost certainly prompted by Powell’s speech, and which took place during a lull in the School’s ‘Troubles’.36 But the government was clearly rattled, and in February 1969 Titmuss’s old ally, Judith Hart, wrote to Wilson. Callaghan, the target of Titmuss’s anger a few months earlier, had sent her a copy of his minute to Wilson on immigration. She very much welcomed his proposal to publish a White Paper on government policy, and thought it would help on ‘all fronts, particularly if it contains, as seems to be the intention, a clear statement of our philosophical approach’. Both the Labour Party and the ‘radical reformers outside the Party’ would ‘appreciate such a statement’.37 Titmuss, meanwhile, directly attacked Powell. After another of the latter’s inflammatory speeches, he wrote to The Times in June 1969. Titmuss started by pointing out that Powell’s views had been condemned by a number of organisations and individuals, including the body on which he sat, the Community Relations Commission. But he wanted to focus on one particular aspect of the effect of Powell’s rhetoric, the ‘untold harm’ he was doing in ‘increasing the unwillingness of some local authorities to cooperate with the Commission and

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its network of local community relations councils’. There was already evidence of this, and in some cases of ‘opposition among some local authorities to the whole concept of community relations’.These bodies would be further encouraged by Powell’s calls for repatriation. But every speech Powell made ‘only increases the need for more and not less money to be spent in order to encourage harmonious relationships and combat racial discrimination’.38 Perhaps in recognition of his stance on race relations, in 1969 Titmuss was invited to be a sponsor of the London-​based Martin Luther King Foundation, to which he agreed.39 King had visited London five years earlier, taking the opportunity to alert Britons to the dangers of, for instance, housing segregation.40 Titmuss continued to engage with race relations in speeches, writings, and other interventions. Although the Community Relations Commission could undoubtedly be criticised, nonetheless Titmuss was prepared to defend its work, just as he was contemporaneously prepared to defend the SBC. In late 1969, he was quoted to the effect that ‘a substantial number’ of community relations officers were taking ‘constructive and innovative initiatives’, while the agitation of Community Relations Councils had ‘moved a great many local authorities to realise that there is a problem in situations where most local government had not accepted its responsibility’.41 In a speech in 1971 at South Bank Polytechnic,Titmuss emphasised the interconnectedness of a number of his preoccupations, including race relations. He started by noting his pleasure in accepting the polytechnic’s invitation, for two reasons. First, this contributed to ‘building bridges’ between different sectors of higher education (polytechnics were, at that time, in the second tier of British higher education, and often vocationally oriented). Second, he received many invitations to speak, and so had to make choices. His preference was not for elite institutions, ‘the Oxbridges and the lush campuses of Canterbury, Essex etc’ –​the last almost certainly a dig at Townsend. He attributed this preference to ‘my upbringing or lack of it’.This ‘man of the people’ routine does not show Titmuss at his best, but clearly played into the sort of image that he (and Kay) had constructed of himself. More to the point, he suggested that both wealth and poverty were ‘relativities’, and here he cited W.G. Runciman’s Relative Deprivation and Social Justice. Such ‘relativities’ could not, moreover, be discussed in Britain ‘outside the context of the two great World issues of The Third World and Race Relations’. It was not possible to ‘have a moral view about one’s own community (or parish) without also connecting that view with the state of the world outside’, a theme he had tried to develop in The Gift Relationship.42 The interconnectedness to which

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Titmuss alluded again illustrates his aspiration to analyse social problems holistically, and on a global scale, rather than as separate issues.

The Common Market In 1961 Britain made its first application to join the EEC, provoking what one commentator describes as two years of ‘often virulent public debate’.43 The Conservative government was strongly in favour. The Labour Party was divided, with revisionists generally in favour, the left generally hostile. Gaitskell, one of the former, stressed, at Labour Party conference in October 1962, that while he opposed entry on the government’s terms, he was not, in principle, against membership.44 At almost exactly the same time, in the WEA lecture discussed in Chapter 15 and again earlier,Titmuss addressed the subject. He was sceptical, as he was to remain. Discussions about British entry had not explained how this would result in, for example, a more equitable distribution of wealth. If such values were implicit in the current emphasis on the economic benefits of membership, then ‘Why not make them explicit? Why is there so much silence about the effects of Common Market arrangements on the standards of social justice which have been built up so painfully in Britain during the past hundred years?’ As things stood, the stress was ‘in almost nineteenth century terms –​on the advantages of greater economic and political power’. But anyone aware of, for instance, the treatment of unmarried mothers in France and Germany would not be reassured.45 Robert Pinker was to recall, some 50 years later, that Titmuss wrote a piece in Encounter about our failed first attempt to enter the Common Market saying that basically the statutory social services of the other member states weren’t quite morally up to our standard.They weren’t quite good enough. Basically it was a little England view.

Revealingly, Pinker put this in the context of the lack of comparative social policy on the undergraduate course, and Titmuss’s hostility to such approaches.46 This is a rather harsh judgement, given Titmuss’s engagement with certain other countries, but Pinker’s point nonetheless reminds us of the former’s essential Englishness. To add to this, there was a generational effect, with those over 45 (Titmuss was 54) more hostile to a closer relationship with Europe. In similar vein, it has likewise been suggested that Britain’s wartime experience had ‘stimulated a sense of otherness and detachment from Continental Europe’.47 In

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the light of Titmuss’s own historical interpretation of the Second World War, this also resonates. The article to which Pinker referred was one of a series seeking the views of the ‘intelligentsia’ on EEC entry. Titmuss admitted that he, like many others, was in a ‘great state of confusion’, and puzzled by the economic arguments being put forward. More importantly, though, this was ‘a fundamental question about political values’. So would membership ‘allow and encourage us simultaneously to be more civilised and more compassionate’? Titmuss was not reassured, citing, as in his WEA talk, French and German social policies, aspects of which ‘can hardly be classified as modern or dynamic’. Somewhat disingenuously, he concluded that ‘perhaps all this is irrelevant. If it is, I will cheerfully go on being thought a troglodyte’. Interestingly, around three quarters of those polled by Encounter expressed various degrees of enthusiasm for joining, so Titmuss was very much in a minority of those questioned.48 He was also aware that other versions of the development of European social welfare were available. In January 1961 an article appeared in The Observer entitled ‘Wages and Welfare’, and Titmuss highlighted the following passage: Apart from the National Health Service, where Britain still leads, the social services in several Continental countries are by now considerably wider, more generous and have been growing faster than here. That is especially true of the care of the old. It is remarkable how little fuss there has been in Germany about the successive increases in old-​age pensions in each of the last three years. Contributions have gone up automatically as people’s incomes have risen, and so the old-​age pensioner has benefitted just as automatically from the increase in national wealth.49

Here was an example of a society, West Germany as it then was, experiencing strong economic growth with built-​in mechanisms for improving social welfare. It was also one of the driving forces of the EEC. We might speculate what Titmuss felt about this. Given his interest in pensions, did he pick out the piece because he thought it fundamentally flawed? It is difficult to know, but it at least suggests Titmuss’s interests were less parochial than is sometimes claimed. And he was certainly well known in Europe, being, for example, one of a small group of specialists attending the meeting of ‘European Experts in Social Policy’ in Copenhagen in 1965.50 Nonetheless, Titmuss remained hostile to Common Market membership. In June 1970 he was one of the signatories to a letter arguing

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that the apathy surrounding the impending general election –​it was to take place two days later –​was manifested by the lack of discussion of international development, something to which Britain’s own economic future was closely tied. More pressingly, the ‘imbalance of the rich and the poor in the world grows greater daily’. Those for whom ‘poverty, hunger, lack of medical care, absence of work, wherever in the world they occur, constitute an indivisible problem and an offence against our common humanity, see this as a moral issue’. Here, then, was an area where Britain should play a leading part, not least because the country ‘desperately’ needed a world role.51 This letter resulted in Titmuss being approached by the Labour politician, and longstanding acquaintance, Douglas Jay. Jay wanted him to become a patron of the Common Market Safeguards Campaign, which had been ‘largely formed in order to oppose entry into the Common Market on terms which would be damaging to developing countries in the Commonwealth or outside’. Titmuss agreed.52 The Campaign’s creation was widely noted with, for example, the Western Mail recording its 32 new patrons, including ‘Professor Richard Titmuss, an expert on pensions and insurance’.53 Illustrating the cross-​party nature of opposition to the EEC, Jay worked closely on the issue with Enoch Powell, Titmuss’s adversary on welfare and immigration.54 Titmuss was signatory, in 1971, to an advertisement taken out by the Campaign in The Times under the headline ‘Let the People Decide’, which claimed that ‘the majority of the British public are right in rejecting the terms now proposed for British entry into the Common Market’. Few safeguards had been secured, while no ‘firm and lasting safeguards have been obtained for Commonwealth countries, rich or poor’. Entry on the terms currently proposed would ‘inflict grave economic damage and political weakness for the foreseeable future’, resulting in a commitment ‘against the wishes of most of our people to ever greater sacrifices of national independence’.55 But opinion was shifting, including in the Labour Party, and, shortly thereafter, Parliament voted to join Europe.

Conclusion Stefan Collini comments that, in the twenty-​first century, Titmuss ‘remains an under-​explored and somewhat shadowy figure’. This is a reasonable point, and something this volume seeks to address. Collini also suggests that Titmuss had a ‘relatively low public profile during his lifetime’, partly because of the nature of social policy.56 This is more debatable. From the outset,Titmuss sought to bring his ideas to as wide

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an audience as possible, and from the 1940s this embraced broadcast, as well as printed, media. As this chapter has shown, he also contributed to discussions outside any narrow, academic, definition of ‘Social Policy’ on controversial topics such as race relations, Vietnam, and the EEC. As such, he was surely a public intellectual, one of ‘the great and the good’, and a participant in what has been described, referring to the first few decades after 1945, as the ‘golden age of the don’. Notes 1 TITMUSS/​7/​73, ‘Copy of Cable Sent on February 22, 1962’. 2 TITMUSS/​7/​72, letters, 3 March 1964, Martin to RMT, and 20 March 1964, RMT to Martin. 3 NRS, COM6/​2/​11, National Incomes Commission, ‘Minutes of Proceedings at a Hearing with Reference to the Remuneration of the Academic Staff of Universities and Colleges of Advanced Technology, 22nd October 1963, Eleventh Day’, pp 13, 15. 4 S.A. Ellis, ‘Promoting Solidarity at Home and Abroad: The Goals and Tactics of the Anti-​Vietnam War Movement in Britain’, European Review of History/​Revue européenne d’histoire, 21, 4, 2014, pp 560–​66, and passim. 5 TITMUSS/​7/​73, letter, 10 December 1965, Redgrave to RMT. 6 The Times, 23 December 1965, p 5. 7 TITMUSS/​7/​74, letter, 30 December 1965 Kaiser to RMT. 8 TITMUSS/​7/​74, telegram, 23 December 1965, editor of Time and Tide to RMT. 9 ‘The 17 men who advertise their “alarm” over war in Vietnam but stay silent on the use of force in Rhodesia’, Time and Tide, 6–​12 January 1966, p 11. 10 TITMUSS/​7/​74, letter, ? July 1966, RMT and Glass to the editor of The Times, and response. 11 Letter, 4 July 1966, Dr P. Abrams and others, ‘US Activities in Vietnam’, The Times, p 11. 12 TITMUSS/​3/​370, typescript ‘The Irresponsible Society:  A Re-​Assessment’, pp 1, 2. 13 R.M. Titmuss, letter to The Times, 17 October 1961, p 13. 14 Quoted in P.M. Williams, Hugh Gaitskell, Oxford, Oxford University Press, 1982, p 385. 15 ‘The Rich Will Gain, the Needy Pay’, Tribune, 22 October 1965, p 7. 16 R. Crossman, The Diaries of a Cabinet Minister:  Volume 1, entry for 14 November 1965. 17 TITMUSS/​7/​74, Anti-​Apartheid Movement Press Release, 21 June 1966, ‘Declaration on Rhodesia’. 18 TITMUSS/​7/​73, letter, 24 May 1965, Lester to RMT. 19 TITMUSS/​1/​16, Minutes of the Labour Party Social Policy Advisory Committee, 27 January 1966. 20 ‘Primate Heads Immigrants’ Advice Body’, The Times, 18 September 1965, p 5. 21 Oakley, Father and Daughter, p 179; Professor Adrian Sinfield, email to author, 18 May 2018. 22 National Committee for Commonwealth Immigrants, Report for 1967, London, NCCI, nd but presumably 1968.

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A public figure in troubled times 23 National Committee for Commonwealth Immigrants, Summary of the PEP Report on Racial Discrimination, London, NCCI, nd but probably 1967, p 3. 24 National Committee for Commonwealth Immigrants, Anti-​Discrimination Legislation: A Summary of the Street Report, London, NCCI, 1967, p 3. 25 National Committee for Commonwealth Immigrants, Report for 1967, p 12. 26 See Report of the Community Relations Commission for 1968–​69, London, HMSO, 1969 for the Commission’s founding. 27 Flyer, Community Relations Commission: What It Does,Who Is On It,What It Does, Its Priorities, and How It Works, CRC, nd but 1968 or 1969. Consulted in Nuffield College Library, Oxford. 28 Letter from P. Calvocoressi and others,‘The Turning Point’, The Times, 27 February 1968, p 9. 29 ‘Racialist Law for Britain’, Tribune, 1 March 1968, p 1. 30 TITMUSS/​7/​76, letter, 1 March 1968, Judd to RMT. 31 TITMUSS/​7/​76, letter, 6 March 1968, RMT to Judd. 32 TITMUSS/​5/​662, letter, 18 March 1968, Katz to RMT. 33 R. Crossman, The Diaries of a Cabinet Minister: Volume 2, entry for 8 March 1968. 34 R. Titmuss and P. Townsend, letter, ‘We Won’t Quit the Labour Party’, Tribune, 8 March 1968, p 8. 35 ‘Immigrants Committee See Wilson’, The Daily Telegraph, 15 March 1968, p 21. 36 TITMUSS/​7/​76, letter, 16 May 1968, Colin Crouch, President LSE Students’ Union, to RMT. 37 HART, Hart/​13/​17, memo, 21 February 1969, Hart to Wilson. 38 R.M. Titmuss, letter, ‘Mr Powell’s Speeches: Effect on Community Relations’, The Times, 14 June 1969, p 9. 39 TITMUSS/​7/​77, letter, 3 February 1969, Dora Bullivant to RMT. 40 ‘Dr King’s Warning to Britain’, The Guardian, 7 December 1964, p 18. 41 ‘Race Group Expands in Spite of Criticism’, The Guardian, 24 November 1969, p 5. 42 TITMUSS/​3/​370, typescript for speech on ‘Poverty and Social Policy’ given at South Bank Polytechnic, 3 May 1971. 43 M. Haeussler, ‘The Popular Press and Ideas of Europe:  The Daily Mirror, the Daily Express, and Britain’s First Application to Join the EEC, 1961–​63’, Twentieth Century British History, 25, 1, 2014, p 108. 44 Williams, Hugh Gaitskell, Ch 23. 45 TITMUSS/​3/​370, typescript ‘The Irresponsible Society: A Re-​Assessment’, p 10. 46 LSE, Department of Social Policy, Oral History Project, Professor Robert Pinker interviewed by Sonia Exley, 30 November 2012, p 8. 47 Haeussler, ‘The Popular Press’, pp 112–​13, 123. 48 Encounter, March 1963, pp 77, 68. 49 TITMUSS/​2/​147, clipping, A. Shonfield, ‘Wages and Welfare’, The Observer, 22 January 1961. This file is largely a collection of such newspaper extracts. 50 TITMUSS/​4/​585, ‘The Copenhagen Meeting of European Experts in Social Policy 1965. February 1965’.The meeting, with around a dozen participants, took place in spring 1965. Another key figure was Henning Friis, with whom Titmuss had been in contact since at least the late 1950s, and with whom he shared an interest in pensions.Titmuss’s paper,‘Models of Redistribution in Social Security and Private Insurance’, was reprinted in Commitment to Welfare. 51 J. Boulting and others, ‘Issues before the Electorate: World Development’, The Times, 16 June 1970, p 11.

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RICHARD TITMUSS 52 TITMUSS/​7/​78, letters, 22 June 1970, Jay to RMT, and 26 June 1970, RMT to Jay. 53 TITMUSS/​6/​679, clipping, Western Mail, 30 June 1970. 54 P. Corthorn, Enoch Powell: Politics and Ideas in Modern Britain, Oxford, Oxford University Press, 2019, p 119. 55 ‘Let the People Decide’, The Times, 7 June 1971, p 5. 56 S. Collini, Common Writing: Essays on Literary Culture and Public Debate, Oxford, Oxford University Press, 2016, p 200.

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27 Healthcare, the market, and the Institute of Economic Affairs: the making of The Gift Relationship Introduction Throughout the 1960s Titmuss engaged in an acrimonious dispute with the Institute of Economic Affairs over the market’s role in healthcare provision.1 More positively, this ultimately resulted in one of his most significant works, and last major book published in his lifetime, The Gift Relationship. Here, as well as dealing with the mechanics of the acquisition and use of blood for medical purposes, Titmuss sought to articulate, as advertised on the cover of the first edition, his ‘social philosophy’. For Titmuss, the contrast between the British and American methods of securing blood was marked.The former rested on voluntary donations, and for proponents of altruism in welfare this situation was truly exemplary. Donors gave their time freely, donated their blood at no charge, and could not know who might receive their donation –​an instance of the kindness of strangers.Voluntary workers, too, were an important part of a system which existed within a necessary framework of universal healthcare provision. In America, blood was often sold by impoverished donors to for-​profit blood banks, arguably laying blood supplies open to contamination, and to potential shortages.The British system was thus both morally superior and more efficient. As we saw in Chapter 24, The Gift Relationship had an impact on American opinion and policy, something returned to below when considering the book’s reception.

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Early skirmishes In spring 1963, Titmuss’s ‘Ethics and Economics of Medical Care’ appeared in the first edition of the journal Medical Care. Titmuss was involved in this publication’s creation, a member of its editorial board, and had participated in its inaugural press conference, agreeing to say ‘a few words from the “social” point of view.2 He clearly saw Medical Care as a suitable outlet for his ideas on healthcare and the market, a feeling which was reciprocated. The editor, Dr Abraham Marcus, told him that he was ‘very glad indeed that you are going to write on the subject’.3 In his article, Titmuss noted the introduction of Britain’s ‘free-​on-​demand health service’ in 1948, something which was not ‘in its essential principles a novel event’, given historical precedents. However, in the work of economists associated with, especially, the IEA and the American Medical Association, the NHS was now regarded as ‘a unique aberration’. Titmuss questioned whether a free market in medical care had existed historically, and whether medical ethics would survive in a free market system. In such a system doctors would lose their role as the ‘centres of moral life’, while medical students would be taught to ‘give preferential treatment to consumers who will pay most for what they have to sell’. Advances in medical science, furthermore, had produced ‘an immense enlargement –​in relative terms –​in the average patient’s ignorance about medical matters’. Consumer sovereignty could not, therefore, apply to healthcare. But a throwaway comment was to land him in trouble. In Britain the case for a free market in the social services had been ‘ably presented by economists and other writers on behalf of the Conservative and Liberal Parties’, something which needed ‘no documenting here’. Just to make sure, though, he footnoted works by, among others,Arthur Seldon.4 In some respects, Titmuss was simply expanding here upon long-​held views. A few years earlier, for instance, he had linked ‘corruption and competition’ in a discussion of the changes in healthcare brought about by the 1911 National Insurance Act.5 The consequences of Titmuss’s throwaway remark took several months to make themselves felt. In the meantime, his article almost immediately attracted attention in the US, with a number of academics and practitioners contacting him about it.6 In a piece in the American Harper’s Magazine, also in early 1963, he expressed dismay at the ‘extent and character of misconceptions about the British Health Service’. Titmuss challenged these ‘misconceptions’, giving as an illustration of the NHS’s success the thriving voluntary contributions to the National Blood Transfusion Service. Reflecting on American healthcare, his

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recent visit had brought home to him ‘a deep sense of frustration about the power of organized medicine … and widespread feelings of cynicism in the face of rising medical costs’. One outcome was that the cost of medical care was, as a proportion of gross national product, greater than in Britain.7 The ‘power of organized medicine’ was also being bolstered by support from Britain. In August 1963, Titmuss wrote to Marion Sanders, editor of Harper’s Magazine. He had been disturbed by the publicity given in the British press to the IEA publication, Choice in Welfare. Equally disturbingly, in ‘the last few days several distinguished American visitors have told me that the report is also receiving publicity in the US’. Given the political implications, namely current proposals to reform American healthcare, these visitors were anxious lest the IEA line be uncritically accepted. The Institute was good at publicity, and ‘appears to be financed largely by insurance companies, pharmaceutical firms, advertising agents, and brewers’. The latest publication was methodologically flawed, could not be considered ‘a serious contribution to social research’, and it would be regrettable were it to influence American social policy. Could Titmuss, or one of his colleagues, respond in her journal?8 Sanders was sympathetic, noting that the IEA report would ‘undoubtedly provide much ammunition’ in the coming months for opponents of socialised medicine, but her schedules were full.9 Soon Titmuss had more immediate problems, however. In late 1963, three articles were published in Medical Care, authored by John and Sylvia Jewkes, D.S. Lees, and Arthur Kemp.10 John Jewkes, an Oxford economics professor, had served as an economist in the War Cabinet. As a result of his wartime experiences he had written Ordeal by Planning, later a favourite of Margaret Thatcher’s.11 He was also a founding member of the free-​market think tank, later to have close links with the IEA, the Mont Pèlerin Society. His interest in medical issues arose from membership of the Royal Commission on Doctors’ and Dentists’ Remuneration, a body criticised by Titmuss in Income Distribution and Social Change.12 He and his wife had recently published Genesis of the Health Service, which took Titmuss to task for misinterpreting statistics, and overstating the pre-​war hospital system’s flaws, before concluding that ‘History has not infrequently been falsified by those seeking to explain, or indeed defend, great social changes by picturing them as reactions against ancient and intolerable evils’.13 In short, Titmuss was a bad historian. Lees was an economics lecturer at Keele University who, like the Jewkes, had been criticised in Titmuss’s article. Kemp, meanwhile, was Professor of Money and Credit at a college in California. Taken together, their articles argued as follows.

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First,Titmuss’s approach was characterised by ‘dogma’ rather than social scientific analysis. Second, he had distorted the evidence: the NHS was not as good as he claimed, while he had produced an unrecognisable picture of the American situation. Third, Titmuss did not understand how free markets operated, and there was no evidence that ethical behaviour in market economies was worse than in economies of any other kind. Ultimately, there was a choice between the free market and socialised medicine, the latter involving state coercion, of both producers and consumers, and the loss of individual freedom. Assailed in print, Titmuss also had other problems. In late August 1963, he was contacted by solicitors acting for the IEA and Seldon, who was responsible for the organisation’s publications.This concerned Titmuss’s comment on ‘writers on behalf of the Conservative and Liberal Parties’, and the associated footnote. ‘As you are well aware’, the letter claimed, ‘the Institute is independent of any political party or group’, as stated on all its publications. Titmuss’s comments were, therefore,‘defamatory and damaging to our clients’ reputation’. He must withdraw his assertion ‘unreservedly’, and explicitly undertake not to repeat such allegations.14 Titmuss’s response does not appear to have survived, but it was clearly speedy and apologetic, for in mid-​September he received a further letter from the solicitors. The latter’s clients had been consulted, and appreciated Titmuss’s ‘prompt apology’. Matters were not to rest there, though. A copy of Titmuss’s apology had been sent to Medical Care, and he was asked to consent to its publication. As the publishers, Pitman Medical, had not responded to the original complaint, expenses had been incurred as counsel had been briefed. Costs were thus being sought, and in the event of these being paid the matter would be considered closed.15 Titmuss received a further shock when the publishers got in touch in October. It transpired that they had earlier been contacted, by way of a ‘very intemperate letter’, by the IEA, which they had put in the hands of their own solicitors. The latter had found Titmuss’s views, as expressed in his article, ‘fair comment’. Indeed it was possible that some remarks in a letter from Ralph Harris defamed Titmuss. Pitman’s solicitors had conveyed these views directly to the IEA and, since they had heard nothing more, concluded that the matter was closed. The publishers, unwisely as they conceded with the benefit of hindsight, had not contacted Titmuss at this point. But they now had no doubt that Titmuss’s apology had to be published, and were prepared, if necessary, to pay the IEA’s legal costs.16 The matter rumbled on. Harris told Titmuss, in December 1963, that he was ‘very glad to hear from our libel lawyer’ that matters relating to

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his article had been resolved. He and Seldon now proposed to publish the articles in Medical Care by Titmuss and his respondents as an IEA ‘Occasional Papers’. The Institute had contacted Pitman although, as it transpired, this was unnecessary since copyright resided with the authors. Would Titmuss consent to being re-​published in this way? Harris also floated the possibility of a rejoinder by Titmuss.17 Pitman Medical confirmed, in mid-​January 1964, that the IEA was right about copyright, concluding wryly that the whole affair had involved ‘you in a certain amount of unpleasantness and us in a legal case’.18 Shortly afterwards, Titmuss declined Harris’s offer because, ‘after re-​ reading the articles’ by his respondents, ‘it would be quite impossible to reply to them fairly and properly in only 500 words’.19 Harris was disappointed. But the Institute was proceeding with publication, and would ‘fall back on the idea of reproducing such extracts from your article as are necessary’ to make sense of the responses of Jewkes, Lees, and Kemp. All this was legal under the Copyright Act. He agreed this solution was ‘very much a second best’, but all efforts would be made to present Titmuss’s views fairly, and, in the light of this, ‘I shall not bother you further’.20 The collection was published as Monopoly or Choice in Health Services? As Harris had promised, it included an edited version of Titmuss’s article, along with a further piece by Lees.21 Although not all the correspondence is extant, Titmuss was extremely unhappy about the handling of his material. In April 1964, he received a letter from the IEA which, first, apologised for errors which Titmuss claimed had been made. He had, it transpired, also passed on a copy of a letter he proposed to send to The Spectator. The IEA told him that it would take ‘very strong exception’ to this letter’s final paragraph which, in the light of legal advice, might be defamatory. The Institute was thus advising The Spectator not to publish that particular section of Titmuss’s proposed correspondence.22 A draft of Titmuss’s letter exists, allowing us to see what offended the IEA. It begins with an account of the dispute, including the assertion that Medical Care had offered to publish all four articles as a booklet but that this had, effectively, been hijacked by the IEA.The latter went ahead with production, and Titmuss claimed that not only were there misprints in his piece, but that it had been reduced by half.Then came the offending paragraph. ‘These inaccuracies and misrepresentations’ were ‘matters of fact’.What he did not know was whether ‘this action by the Institute in reprinting about half my article verbatim without my permission (or the permission of the Editor of Medical Care)’ was an infringement of copyright law, or simply exploited a loophole in

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that law. He lacked the resources ‘as the Institute has to test the matter in the courts’. But the least he could do was to ‘advise other authors (as well as readers) of the facts’.23 The letter was published on 17 April 1964, without the contentious conclusion.24 Harris responded the following week, disputing Titmuss’s version of events. The other authors were happy with the collection, the typographical errors relatively minor, and it would have been ‘most unfair’ to have gone ahead without something by Titmuss. Harris also suggested the need for a public debate about the issues raised, rather than leaving it to specialist journals such a Medical Care.25

More grief The IEA clearly saw Titmuss as someone to be confronted. Enoch Powell, close to the Institute on many issues, produced a book reflecting on his time as Minister of Health which, nonetheless, broadly defended the NHS. It was reviewed favourably by Titmuss, prompting Harris to write to Powell ‘See how you have comforted the common enemy’.26 In 1967, meanwhile, Melvin Lansky, editor of the Anglo-​American cultural journal Encounter, invited Titmuss to respond to a piece he had recently published by Seldon.27 Seldon had challenged the ‘myth’ and ‘pretence’ propagated by the likes of Titmuss that British welfare provision such as healthcare came free, an idea based on ‘jejune sentimentality about human affairs’.28 Titmuss wrote to various friends noting his receipt of Lansky’s letter, attaching a draft reply, and seeking their advice on how to respond.29 In his draft letter,Titmuss tentatively accepted Lansky’s invitation, but made two important points. First, the IEA’s critics laid themselves open to legal action, and he had suffered in this way. So he had learned, to his cost, that the ‘cut and thrust of academic disputation, personal and impersonal, ideological and philosophical, accepted as customary and, indeed, vital in scholarly circles’ did not, as far as the IEA was concerned, apply.Were the ‘cause … fundamental’, he would ‘hope and pray’ that he would take the risk. But that was not presently the case. In any event, Seldon and his colleagues had repeatedly written on the lines of the Encounter piece, which said nothing new. Second,Titmuss rejected the claims of Seldon and other ‘selectivists’ that they were the true egalitarians. He had done this frequently, and would ‘continue to do so as a socialist’. His arguments had, though, been ignored, as had the issue of racial discrimination. Seldon’s piece had claimed that the market was ‘tone-​deaf ’. But the evidence from the ‘riot-​torn cities of the US and of racial discrimination in Britain’ did not ‘support this claim’.30

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A.H. Halsey told Titmuss that he would ‘Of course … like to join with you in a public fight against the Institute’. But were this to happen, ‘we would certainly have to take very careful legal advice’. Halsey had experienced the IEA’s wrath over a piece on its education policy which had resulted in The New Statesman having to settle out of court.31 Crossman, meanwhile, had been pleased to hear from Titmuss, ‘even if it is only about that nauseating Arthur Seldon’, and he ‘could not agree more with your reply’. A piece he had written for The Guardian had been ‘at once subject to a threat of legal proceedings’. The paper had to ‘settle with an apology, although what I said was correct’. Unlike Halsey, Crossman felt that no legal advice was needed in this particular instance.32 Ultimately, Titmuss rejected Lansky’s offer, explaining that he was going to address the question of the IEA in the soon to be published Commitment to Welfare. The letter actually sent was shorter than the original draft, with the comments about racial discrimination, for example, omitted.Titmuss focused instead on the threat of libel, the IEA’s lack of academic rigour, and the sense that there was at present no pressing need to engage directly with the Institute in Encounter.33 In Commitment to Welfare Titmuss added a postscript (written in late summer 1967, hence just before his correspondence with Lansky) to the original article outlining his dispute with the IEA and addressing his critics. For present purposes, though, what is important is that he flagged up that not only had he specifically dealt with the question ‘Is Human Blood a Consumption Good?’ in Commitment to Welfare, but also that in ‘a forthcoming book, The Gift Relationship, I examine this aspect of medical care in detail’.34

Building his case For Titmuss, one striking example of American healthcare’s shortcomings involved the collection and distribution of blood for transfusion. In early 1966, he told Mike Miller that he planned ‘to revise and expand’ his Medical Care article. In so doing, he would ‘develop the argument by applying economic theory to the problems of blood transfusion and the supply of blood for medical care’. He wanted advice on where to find ‘facts and materials on the development of commercial blood banks in the USA, private markets of blood, prices and costs, the characteristics of blood suppliers, and so forth’.35 A few months later,Titmuss received a journal offprint from another American friend, Odin Anderson of the University of Chicago, concerning a dispute about a blood bank in Kansas City.Titmuss already knew of this, telling Anderson that he had ‘been following with much concern the debates

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over the Kansas Blood Bank case’.36 Titmuss was to incorporate the Kansas dispute in a Fabian Society talk, in late 1966, and later in The Gift Relationship. What sort of case was Titmuss building? When The Gift Relationship was published, among the many who sent their congratulations was F.N.L. Poynter, of the Wellcome Institute for the History of Medicine. Poynter was pleased that the ‘blood transfusion theme’, which Titmuss had ‘first explored’ in a meeting organised by the institute, ‘has now been fully developed into a monograph’.37 This meeting,‘Medicine and Culture: A Historical Symposium’, took place in September 1966. Its proceedings, published in 1969, show Titmuss taking the opportunity to outline his views. Science, technology, and economic growth had ‘transformed medical care into a group process’ involving the ‘organized application of an immense range of specialised skills, techniques, resources, and systems’. To examine ‘medical care from an economic or sociological standpoint’, it was necessary to break this ‘generalized concept into precise and distinctive components’. Titmuss thus took as a case study ‘probably one of the more critical components in curative medicine today, namely the procurement, processing, matching, distribution, financing and transfusion of whole human blood’. He contrasted the systems in New York City and Britain. In the former, notwithstanding that there were over 150 agencies, many operating on a for-​profit basis, there was an ‘acute and chronic shortage of blood’. Consequently, operations were postponed daily, while ‘Professional donors from Skid Row’ and others who made a living by selling their blood were ‘bled more frequently than accepted international standards recommend, and probably three or four more times a year … than in England and Wales’. Blood was, moreover, hoarded as a result of shortages, and, in turn, often wasted. Commercial blood banks therefore had to import blood from abroad, including England. There were other hazards too, but one conclusion was clear. Medical care was, by nature, unpredictable, and the market could not accommodate its vagaries. Commercial practices in blood transfusion involved ‘the consumer in serious hazards to health and life’. Consumers could not estimate in advance the scope of these hazards, and the ‘characteristics of uncertainty and unpredictability are the dominating ones in this particular component of medical care’. Such characteristics were thus the ‘product of scientific advances’ exacerbated, as the situation in New York showed, ‘by the application of economic theories to the procurement and distribution of blood’.38 Discussion followed, with Titmuss criticised by, in particular, Iago Galdston. Galdston was former secretary of the Medical Information

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Bureau of the New  York Academy of Medicine, and author of numerous works on health-​related topics. He warned that the discussion was going to be ‘prickly’, his ‘unbounded admiration’ for Titmuss notwithstanding.Titmuss had parodied ‘the arguments of neo-​classical economists’.Alluding to the theme of the conference, Galdston argued that ‘public markets and private markets have operations which are justifiable in different cultures according to different circumstances’. Claiming that the ‘public market is universally superior to the private market’ was to take an ‘uncultured approach to consumer behaviour’. It was questionable, too, whether blood transfusion was ‘the most critical component in curative medicine today’, given that any individual would have, probably at most, one transfusion in their lifetime. Titmuss, responding, noted that his ‘good friendship’ with Galdston would not be affected by his ‘academic criticisms’ (he probably had the IEA’s rather different approach in mind). He defended his methods, and had focused on blood transfusion not because it was commonplace, but because matters of life and death were involved. He was ‘not saying … that one system is better than another. What I am saying is that different systems of culture or medical care affect the delivery of medical services’.39 Given Titmuss’s hostility to market mechanisms in welfare, this is, at first sight, a rather disingenuous comment. But, as we saw in Chapter 18, he was prepared to propose welfare measures in Africa which differed from those he advocated for Britain. So perhaps Titmuss was, indeed, at least aware of differing cultural contexts. A few months after this meeting, Seldon’s wife, Marjorie, wrote to The Daily Telegraph about its recent article concerning Titmuss’s Fabian pamphlet, Choice and the ‘Welfare State’. Headlined ‘Fabian Attack on US Market in Blood: Contrast with Britain’, this noted Titmuss’s claim that, unlike New York, Britain had no shortages of blood. Titmuss, in a description tailor-​made to enrage Telegraph readers, was described as one of ‘Labour’s leading social planners’, and an opponent of the proposition that social services might be entrusted to ‘consumer choice’ in an ‘increasingly affluent society’.40 Mrs Seldon questioned, especially, the adequacy of British supplies. The previous year her husband had suffered a post-​operative haemorrhage, therefore requiring a considerable transfusion of blood. There was no blood of his type in the hospital he was attending, so a pathologist had to do the rounds of London sources to gain sufficient quantities.The pathologist told Mrs Seldon that her husband had a particularly rare blood type. But this was not the whole issue, for there were shortages of all blood types, and on occasion heart surgeons had to delay operations if the need for large quantities was anticipated. Mrs Seldon then asked: ‘What is

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the evidence on which Prof Titmuss bases his statement that there is no shortage of blood? How does he explain the conflict between his assertion and the pathologist’s experience?’41 Seldon himself needed no encouragement to promote the free market, but his undoubtedly disturbing experience can have done nothing to suggest the efficacy of state-​provided healthcare. The publication which had prompted the Telegraph piece, and, in turn, Mrs Seldon’s indignation, was based on a Fabian Society lecture delivered in late 1966. The pamphlet was, in New Society’s view, ‘the latest blast in the continuing debate’ between Titmuss and economists associated with the IEA.42 In the passage on healthcare, Titmuss first revisited the Medical Care controversy before asserting that it was not a consumption good in the way that, say, consumer durables were. He then contrasted the market for blood in, once again, New York City, and England and Wales. In the latter, there were no shortages, while blood was ‘freely donated by the community for the community’. As such, it was a ‘free gift from the healthy to the sick irrespective of income, class, ethnic group, religion, private patient or public patient’. The question of whether blood was a ‘market good’ was ‘no idle academic question asked in a philosophical mood’, for in America it had become ‘a battle ground for lawyers and economists’. Here Titmuss cited the Kansas City dispute in which costs had run to a quarter of a million dollars. His analysis suggested that there was ‘no support here for the model of choice in the private market’. In New York consumers were not sovereign. On the contrary, they had less choice, while simultaneously exposed to more hazards. Costs were, moreover, increased by waste and bureaucracy, and the system was one which ‘neglects and punishes the indigent, the coloured, the dispossessed and the deviant’.Titmuss then drew ‘one other conclusion from this discussion’, that socialism was about ‘community as well as equality. It is about what we contribute without price to the community and how we act and live as socialists’.43 Titmuss was using blood donation not simply to critique market-​ based approaches to healthcare, but also to show how society, driven by altruism, could operate. Plans for a book, meanwhile, were becoming more concrete. In late 1967 he wrote to Lewis Waddilove, Director of the Joseph Rowntree Memorial Trust, seeking financial support for two book projects. Although an LSE member of staff for 18 years, he had not taken the paid sabbatical leave to which he was entitled. Having reached the age of 60, were he to make any progress on these books, ‘which have been germinating in my thoughts and in my teaching for some years’, they must be written in the near future. The second volume would derive from Titmuss’s course of lectures to social

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work students. This sounds like an early version of the posthumously published Social Policy: An Introduction. The first project, though, was more focused. It concerned the ‘fundamentals of the gift–​reciprocity relationship in modern society’, and was ‘tentatively entitled “The Gift Relationship” ’. He had been collecting material for some time on the ‘ethics and economics of blood transfusion and voluntary action’ in various countries, particularly Britain, the US, and the USSR. The subject had ‘fascinated me; partly I suppose because the whole subject of giving and receiving blood and other non-​economic “gifts” is so deeply rooted in values and human relations’.44 In broad terms, Titmuss’s application was successful. Waddilove was well known to Titmuss, and their acquaintance may have gone back to the early 1940s when the former was involved with evacuation. Titmuss’s engagement with the Trust again illustrates the tight post-​war networks inhabited by like-​minded social reformers. So, for instance, a few months before his application for research support, he chaired a Trust advisory committee monitoring a study of Britain’s housing. In the mid-​1960s, meanwhile, the Trust made a number of small grants, only one of which ‘resulted in a development of any importance’. This was the LSE-​based ‘Occasional Papers on Social Administration’, a series which had been ‘important to the formation of social policy’, but would ‘not have achieved early publication through ordinary commercial channels’.45 So Titmuss already had a history with the Trust. His application also illustrates his endless search for external funding for his, and his department’s, research. This is also shown by his applications to the Nuffield Provincial Hospitals Trust (unsuccessful) and the Nuffield Foundation (successful). The former, despite its outcome, is interesting as it tells us more about the areas Titmuss sought to research. With the help of American colleagues and Dr Maycock of the Lister Institute of Preventive Medicine, he had ‘collected a mass of data relating to the organisation and development of the blood transfusion services’. But little was known of key characteristics of ‘the million or so blood donors in England and Wales’. Maycock had told him, however, that the Ministry of Health held records it would make available if Titmuss provided a research assistant.There was also the possibility of undertaking studies in certain regional centres. Britain had a ‘remarkable record of voluntary blood donations’, and understanding who the donors were was central to his project.46 This application’s failure was shortly afterwards followed by success with the Nuffield Foundation, which in late 1966 awarded a grant of £700. Titmuss acted quickly, taking on Mike Reddin and Sarah West,

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a qualified nurse, as research assistants.47 In spring 1967, he submitted a report to the Foundation. A regionally based statistical study had been made of the blood donation service’s ‘work and achievements’ for the period 1955–​66. A questionnaire was to be sent out, with the aim of further expanding this data. However, progress had been slower than anticipated. Could he have a further £600 to retain West’s services? No School funds were available, and he would prefer not to approach the Ministry of Health as he wanted the study financed from non-​ government sources.48 The answer to this was ‘no’, and so Titmuss then applied, successfully, to the Ministry’s research fund, which granted the required £600.49 The Joseph Rowntree Trust, the Nuffield Foundation, Maycock, Reddin, and West were among those acknowledged when The Gift Relationship was published.The LSE also came up with some money, Titmuss’s pessimism notwithstanding.50 Problems remained, though. In spring 1968, Titmuss told his Nuffield Foundation contact that Reddin had been appointed to a lectureship at the School and had not, as yet, been replaced. Titmuss himself had been ‘unduly pressed with teaching responsibilities at the School, the final stages of the deliberations of the Royal Commission on Medical Education and other commitments’. All this had persuaded him to take, ‘for the first time in my life’, sabbatical leave in the forthcoming Michaelmas and Lent terms, and his priority would be the blood transfusion project.51

The IEA again Titmuss’s battle with the IEA continued. In 1967, he asked Mike Miller, now at the Ford Foundation, for information about another American body, the Relm Foundation. This appears to have been part of the William Volker Fund, a vigorous proponent of the free market, which had been responsible for bringing Friedrich Hayek, the leading intellectual exponent of classic laissez-​faire and inspiration to the IEA, to the University of Chicago.According to Titmuss, the Relm Foundation had given the IEA money, and he wanted to know if it was ‘one of the Foundations used by the CIA’.52 It is not clear what came of this, but it does illustrate Titmuss’s determination to pursue his opponents. Nor did the IEA let up on Titmuss. In 1968, it published a paper by M.H. Cooper and A.J. Culyer, economics lecturers at the University of Exeter. In his preface, Seldon claimed that the authors, notwithstanding the lack of comprehensive data, had made an ‘unanswerable case for a trial period in which the voluntary donor is supplemented by the fee-​paid donor so that the results can be judged in practice, and not pre-​judged

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by doctrinaire obfuscation’.Without identifying himself as the patient in question, Seldon also suggested that the study derived from the experience his wife had described in The Daily Telegraph.53 There can be little doubt about who was guilty of ‘doctrinaire obfuscation’. Cooper and Culyer argued that commentators on healthcare economics tended to fall into one of two ‘clearly distinguishable camps’. These were, on the one hand, the ‘free marketeers’, who believed that ‘the price mechanism brings order and consistency to the myriad apparently independent decisions taken by members of the community’.The price mechanism was the ‘only system consistent with personal freedom and responsibility’. In the opposing camp were ‘those who have more faith in the ballot-​box and centralised decisions on matters affecting consumer welfare’, and saw medical care as different from other goods. This ‘basic disagreement’ between libertarians and collectivists had recently found an outlet in blood donation.As evidence of the collectivist approach, Titmuss’s Medical Care article and his Fabian pamphlet were cited. Titmuss could be attacked on evidence and methodology. For instance, his observation that the quantity of blood voluntarily donated had gone up by 265 per cent under the NHS was meaningless without knowing what the increase in demand had been. After surveying the available data, which they too acknowledged as patchy, the authors posited a series of conclusions: blood was an economic good ‘and therefore amenable to economic analysis’, pricing had been shown to be feasible, and value judgements and ethical matters should be separated out from economic analysis. Nonetheless, with respect to ethics it would be a ‘curious morality which precluded the sale of blood but which simultaneously was unconcerned by the existence of shortages, current or future’. When the ‘fog of polemics’ cleared, it emerged that ‘payment for blood can be both sensible and humane’.54 By Julian Le Grand’s later account,Titmuss’s reaction was to ‘hit the roof ’.55 But he pressed on. In early 1968 he thanked his friend Rosemary Stevens, then based at the Brookings Institution in Washington, for ‘all your efforts and for the blood bank materials you have sent’. Progress had been made on his book’s draft chapters but had been delayed, temporarily, due to ‘pressures of work in the Department and the Royal Commission on Medical Education’.56 By this point Titmuss was also caught up in the LSE ‘Troubles’. His correspondence file for 1969 contains many letters turning down invitations on the grounds of the School’s problems, and his work on The Gift Relationship. Titmuss, and his publisher Charles Furth, were, understandably, disinclined to take any chances with the IEA. A significant version was available by

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spring 1969 and read by a lawyer, J.C. Medley. Medley told Furth that a reference to Cooper and Culyer was derogatory.The relevant passage could be construed as meaning ‘these two rather bad economists which is obviously what any reader would think having read the previous comments’. Medley commended Furth for having sent him the volume ‘because this is the type of book which I am reading more and more for libel because of the sort of difficulty I have mentioned’. None of his comments, though, would detract ‘in any way from the very clear arguments of Professor Titmuss and I must congratulate him on producing a very worthwhile and interesting book’.57 A few months later, Titmuss told an Israeli audience that his book had been five years in the making, and that its last, ‘philosophical’, chapter had yet to be written. He had sought to employ a ‘typology of the Gift’, utilising the insights of the anthropologists Marcel Mauss, Claude Levi-​Strauss, and Bronislaw Malinowksi. Blood transfusion systems were located more broadly in ‘medical care and other social institutions’, and in Britain its voluntary basis ‘would collapse without the universalism of the NHS’.The argument for a universal welfare system was thus ‘fundamentally a moral one’, and as such raised questions such as ‘What are my obligations to strangers? Who, indeed, is my Stranger?’58 By mid-​1970 the volume was effectively complete.Among those who read drafts were Abel-​Smith, Stevens, and Ian Gough of the University of Manchester’s Department of Social Administration. In July, Gough told Titmuss that his work was a ‘most devastating indictment of those advocating a free market in welfare’. It exposed, ‘in a very concrete way’, the ‘ “ideological” underpinnings of the free market school of economists’. The latter denied any ‘ethical component in their analysis’. But there was, and Titmuss’s insights revealed its ‘non-​integrative, self-​centred, individualist nature’. Replying, Titmuss told Gough that ‘the legal problems have now been settled’, and the volume was due out by the end of the year.59 A few months earlier, Angela Vivian had notified Titmuss that Furth had ‘just been in to collect the book –​he said he wouldn’t have the chance again before he retired … to collect such a book himself. He has, as you know, great faith in its tremendous success’.60 Two and a half years later, Furth ruefully told Titmuss that The Gift Relationship was the only book of his on which ‘anybody has been out of pocket’. But while regretting that greater sales had not been realised, Furth declared himself ‘extremely glad and proud to have published it. I think it will still have achieved your purpose even if it does so without achieving mass sales’. Concluding, Furth encouraged Titmuss to contact him when ready to discuss his next project.61 Sadly, this was not to be as Titmuss died a few months later.

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The Gift Relationship The Gift Relationship came out in late 1970, followed by an American edition in early 1971.62 The US publishers, Pantheon Books, advertised it as a ‘book of the utmost importance’ about, essentially, altruism.63 Titmuss himself was keen to publicise what he clearly saw as a major work. This included a summary article in The Lancet, ‘Why Give to Strangers?’64 He appeared on television, with a programme on his book broadcast in the Thames Television series, ‘Ideas in Print’, on 22 March 1971.65 In America, too, a summary article appeared, with Titmuss arguing that his text ‘disputes both the death of ideology’ –​ Daniel Bell again –​‘and the philistine resurrection of economic man in social policy’.66 Shortly before his death he wrote a preface for a Hebrew edition which claimed that he would have liked to include Israel in his research, ‘because I believe that the moral issues it raises are particularly relevant to Israel –​today and tomorrow’. Such young countries were ‘struggling to avoid the errors that others have made; still searching for the more generous human routes to social justice’.67 What did The Gift Relationship say? Essentially, it brought together all the material we have seen Titmuss embracing in the course of this chapter, albeit in more depth and detail. In Appendix 7, the assistance of over 100 organisations and individuals was recognised. The book’s declared starting point was ‘human blood: the scientific, social, economic and ethical issues involved in its procurement, processing, distribution, use and benefit’ in Britain, the US, and elsewhere. The characteristics of donors were also analysed. All this was backed up by a deluge of statistical data, displayed in the original edition in 18 tables in the main body of the text, and in a further 24 in the seven appendices. For instance, Appendix 3 provided a statistical analysis of data on blood donations by region for England and Wales, noting that the ‘general trend’ in giving was ‘remarkably consistent, and shows that all parts of the country contributed to meeting the rising demand for blood’ from the NHS.68 Titmuss’s empiricism sat alongside, and was complementary to, his ‘social philosophy’. He utilised the research of other social scientists, notably Marcel Mauss’s The Gift, brought to his attention by his son-​ in-​law, the sociologist Robin Oakley.69 Titmuss approvingly remarked that this work showed how ‘non-​economic giving’ told much about ‘the texture of personal and group relationships in different cultures, past and present’.While modern societies had gained much from ‘large-​scale economic systems’, this had been at the expense of exchanges based on a ‘moral transaction’ which engendered ‘personal relationships between

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individuals and groups’. Titmuss also cited the German sociologist Ferdinand Tönnies (‘strangely neglected by the French anthropologists’, apparently), who had contrasted giving in community-​based societies with those where ‘economic man’ predominated. In the former, giving was based on mutuality, in the latter on instrumentality. Morality was crucial, and Titmuss’s approach to social policy sought to give it a moral foundation, so promoting the kind of relationships which had, to some degree, been lost. Specifically, social policy should enable altruism, and ‘no money values can be attached to the presence or absence of the spirit of altruism in a society’. While voluntary blood donation was indicative of the exercise of altruism, the latter ‘may touch every aspect of life and affect the whole fabric of values’. Humans had a ‘biological need’ to help one another, nowhere more so than in modern societies. In one of the book’s most striking passages, Titmuss suggested that those giving blood voluntarily were ‘taking part in the creation of a greater good transcending the good of self-​love’. In order to ‘love’ themselves, donors had ‘recognized the need to “love” strangers’. All this was antithetical to the operations of the free market. Indeed, one of the ‘functions of atomistic private market systems’ was to undermine the sense of social obligation individuals felt towards one another, regardless of the consequences.70

Reading The Gift Relationship As noted in Chapter 24, The Gift Relationship was well received in the US, at least by like-​minded colleagues. Wilbur Cohen told Titmuss that he had recently received the book, and was ‘now reading it with great interest’. Cohen admired Titmuss’s ‘capacity to explore new and fascinating topics and to present them in an exciting way’.71 Another correspondent was Henry Barnett, of the Albert Einstein College of Medicine in New  York, who enclosed a copy of his recent article, ‘Altruism Rediscovered’. In it, Barnett surveyed The Gift Relationship, for the most part favourably. Barnett also examined its implications for blood donation in the US and how, as shown by Titmuss, the marketplace could generate moral conflict.72 In reply,Titmuss remarked, in a further expression of his core beliefs, that ‘Human beings in the States as well as in Britain and other countries do have a sense of moral obligation to strangers but that can be blunted or eroded by the growth of materialistic values’.73 And, illustrating that altruism could, indeed, operate in the US, Titmuss was asked to be principal speaker at the 1972 Connecticut Red Cross Blood Program Symposium. The Red Cross had, since 1950, been the state’s sole procurement source for

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blood, and so ‘in many respects our Blood Program resembles’ that in Britain.Titmuss was being invited, he was flatteringly told, because ‘we are in urgent need of the knowledge you can impart and the matter of fact objectivity that is apparent in your book!’ The invitation was declined, but Titmuss commented that it was ‘quite clear to me that the Connecticut Red Cross Blood Program is doing a remarkable job in sustaining the voluntary principle’.74 In the New Statesman, meanwhile, David Owen, future Labour Cabinet Minister, claimed that Titmuss had ‘dominated post-​war social theory’. The Conservative government was planning to undermine universal, free, access to the NHS.Titmuss had made ambitious claims about the service, but ‘in this profound case-​study of the provision of blood for transfusion’ had ‘quantified to an extent that has hitherto seemed impossible the real moral values that underpin the most significant piece of social legislation undertaken in the 20th century’.75 Another prominent Labour politician (and lecturer in Titmuss’s department), Michael Meacher, told Tribune readers that the book was a ‘blistering indictment of commercialised health programmes’ at a time when the NHS appeared to be under ‘severe attack’.76 The sense of urgency evoked by Owen and Meacher was a response to the ongoing demands, by free marketeers, for fundamental changes in healthcare funding and provision. As yet, such demands gained, in policy terms, little purchase. Nonetheless, the threat no doubt felt real enough to those on the political left. Others, though, were more critical. François Lafitte, now a Professor of Social Policy, acknowledged his old friend’s book as a ‘fascinating study’. With ‘characteristic erudition’, Titmuss had ‘brilliantly’ vindicated his critique of America’s methods of blood collection and distribution. More problematic, though, was his ‘social philosophy’. Lafitte questioned the attempt to establish social policy’s moral basis through ‘rather dubious analogies with “gift exchange” in primitive societies’. And appeals to undefined abstractions such as ‘fellowship’ could equally be made by, on the one hand, contemporary Maoist China and, on the other, R.H. Tawney. For Lafitte, the ‘genuinely free market’ remained the only existing guarantor of personal freedom. In rejecting the ‘utopians of the Right’, Titmuss ignored the benefits the free market could bring. In so doing, he ‘unwittingly runs the risk of being labelled a utopian of the Left’.77 The IEA, meanwhile, took The Gift Relationship extremely seriously, producing a collection of essays critically engaging with Titmuss’s arguments. Culyer, for example, claimed that it was ‘not easy to extract the core of [Titmuss’s] analysis’. But, in his interpretation,Titmuss had

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a ‘view of freedom [which] tended to be coercive’. This was at the heart of the ‘so-​called paradox of liberalism, that men are forced to be free’ which was ‘not really a paradox, but merely a statement about the preferences characteristically held by liberals’.78 Shortly after Titmuss’s book appeared, Seldon told Keith Joseph that he had woken early one morning and ‘punished myself for an hour reading a couple of chapters of Titmuss. After that I felt better –​or worse’. Ben Jackson suggests, surely correctly, that these chapters came from The Gift Relationship.79 The American reception was also mixed. The New York Times asserted that The Gift Relationship ‘should make it clear in this country, as it has long been clear in Britain’, that Titmuss was ‘a major figure in contemporary sociology’. Such was the clarity of his exposition that it ‘should shame the Pharisees of number sociology’.80 The same newspaper chose Titmuss’s book as one of seven of special significance published in 1971. It had ‘the elegance of literature and the immediacy of a news bulletin’.Titmuss had combined the ‘humane insights of a social philosopher with the muck-​raking energy of an investigative reporter’, producing a ‘dramatic book, written with great clarity and with great courtesy to the common reader’.81 In its ‘Christmas Books’ section, The Lancet pointed to the ‘pride of place’ accorded by The New York Times. This was possibly unprecedented for a book ‘which demands such close attention to the medical, scientific, and economic issues’. If, on Christmas Day, a large number of the ‘American public find this book in their stockings, read it, and reflect on it, only good can result’. It would also ‘make a superb present to all those politicians who are now turning their attention to medical affairs’.82 Other American commentators, however, were unconvinced. An economist and a lawyer who had worked on the Senate hearings on blood banks argued that Titmuss had written a ‘bad book’. He had, for instance, misused the evidence from the Senate hearings in which they were involved. More broadly, the two parts of the book, about blood banks and about social ethics, were both unfinished while ‘the parts don’t fit together very well’. In what was clearly meant to be a damning criticism, although Titmuss may not have taken it that way given his views on orthodox economics and undue legalism, it was suggested that the volume ‘does nothing to support his reputation as an economist’.83

Conclusion Titmuss’s drawn-​out, draining dispute with the IEA should be seen in the broader context of debates about the market’s role in welfare

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provision, debates with which he had been actively engaged from the early 1950s, although they took a particularly acrimonious turn in the subsequent decade.Through his focus on the acquisition of blood, Titmuss forcefully highlighted what he saw as the market’s inefficiencies and amorality, and, by contrast, the virtues of altruism. Altruistic behaviour was, by this account, enabled by universal social services, and so allowed individuals to care for ‘strangers’. It was also an expression of individual choice and individual freedom. The questions were already being asked, though, and would be asked with greater voice in the coming years –​is this an adequate account of human behaviour, and a sufficient basis for the provision of social welfare? Notes 1 See also P. Fontaine, ‘Blood, Politics, and Social Science: Richard Titmuss and the Institute of Economic Affairs’, Isis, 93, 3, 2002, pp 401–​34; and B. Jackson, ‘Richard Titmuss versus the IEA: the Transition from Idealism to Neo-​Liberalism in British Social Policy’, in L. Goldman (ed), Welfare and Social Policy in Britain since 1870: Essays in Honour of Jose Harris, Oxford, Oxford University Press, 2019, pp 147–​61. 2 TITMUSS/​2/​300, letters, 2 May 1962, D.K.C. Dickens, Pitman Medical Publishing, to RMT, and 9 October 1962, RMT to Dickens; and TITMUSS/​ 2/​177, letter, 5 November 1962, Dickens to RMT. 3 TITMUSS/​2/​300, letter, 19 July 1962, Marcus to RMT. 4 R.M. Titmuss, ‘Ethics and Economics of Medical Care’, Medical Care, 1, 1, 1963, pp 16, 17, 18, and passim. Reprinted in Commitment to Welfare. 5 R.M. Titmuss, ‘Health’, in M.  Ginsberg (ed), Law and Opinion in England in the Twentieth Century, London, Stevens and Sons, 1959, p 313. Reprinted in Commitment to Welfare. 6 For instance, TITMUSS/​7/​71, letter, 29 May 1963, Howard J. Parad, Director, Smith College School for Social Work, to RMT. 7 R.M. Titmuss, ‘What British Doctors Really Think about Socialized Medicine’, Harper’s Magazine, 1 February 1963, pp 18–​26. 8 TITMUSS/​7/​71, letter, 27 August 1963, RMT to Sanders. 9 TITMUSS/​7/​71, letter, 3 September 1963, Sanders to RMT. 10 Medical Care, 1, 4, 1963, J.  and S.  Jewkes, ‘Ethics and Economics of Medical Care: One’, pp 234–​6; D.S. Lees,‘Ethics and Economics of Medical Care: Two’, pp 237–​40; and A. Kemp,‘Ethics and Economics of Medical Care: Three’, pp 241–​4. 11 J. Jewkes, Ordeal by Planning, London, Macmillan, 1948. 12 For Jewkes see R. Cockett, Thinking the Unthinkable: Think-​Tanks and the Economic Counter-​Revolution, 1931–​1983, London, HarperCollins, 1994; R.M. Titmuss, Income Distribution and Social Change, London, Allen and Unwin, 1962, p 16. 13 J. and S. Jewkes, The Genesis of the British National Health Service, Oxford, Basil Blackwell, 1961, pp 13, 21, 46. 14 TITMUSS/​2/​182, letter, 28 August 1963, Oswald Hickson Collier and Co to RMT. 15 TITMUSS/​2/​182, letter, 11 September 1963, Oswald Hickson Collier and Co to RMT.

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RICHARD TITMUSS 16 TITMUSS/​2/​182, letter, 3 October 1963, Dickens to RMT. 17 TITMUSS/​2/​182, letter, 23 December 1963, Harris to RMT. 18 TITMUSS/​2/​182, letter, 15 January 1964, Dickens to RMT. 19 TITMUSS/​2/​182, letter, 24 January, RMT to Harris. 20 TITMUSS/​2/​182, letter, 28 January 1964, Harris to RMT. 21 IEA, Monopoly or Choice in Health Services? Occasional Paper 3, London, IEA, 1964. The copy held at Archives and Special Collections at the BLPES has annotations, authorship unknown, including on the cover:  ‘No, no  –​Three Papers. One approach, to invalidate Titmuss’s arguments’. 22 TITMUSS/​2/​182, letter, 9 April 1964, J. Culvervell to RMT. 23 TITMUSS/​2/​182, draft undated (but spring 1964) letter, RMT to the Editor of The Spectator. 24 R.M. Titmuss, letter, The Spectator, 17 April 1964, p 515. 25 R. Harris, letter, The Spectator, 24 April 1964, pp 545–​6. 26 Cited in P. Corthorn, Enoch Powell: Politics and Ideas in Modern Britain, Oxford, Oxford University Press, 2019, p 61. 27 TITMUSS/​2/​182, letter, ? November 1967, Lansky to RMT. 28 TITMUSS/​2/​182, offprint from Encounter, A.  Seldon, ‘Crisis in the Welfare State: Some Sceptical Thoughts’. 29 TITMUSS/​2/​182, letters, 16 November 1967, RMT to Crossman et al. 30 TITMUSS/​2/​182, draft letter, 16 November 1967, RMT to Lansky. 31 TITMUSS/​2/​182, letter, 20 November 1967, Halsey to RMT. 32 CROSSMAN, MSS.154/​3/​LPO/​15/​14, letter, 22 November 1967, Crossman to RMT. 33 TITMUSS/​2/​182, letter, 27 November 1967, RMT to Lansky. 34 R.M.Titmuss,‘Postscript to Ethics and Economics of Medical Care,August 1967’, in Commitment to Welfare, pp 263–​8. 35 TITMUSS/​6/​702, letter, 27 April 1966, RMT to Miller. 36 TITMUSS/​AO, letters, 23 November 1966,Anderson to RMT, and 6 December 1966, RMT to Anderson.The Kansas case is discussed in Fontaine,‘Blood, Politics, and Social Science’, p 415. 37 TITMUSS/​7/​79, letter, 1 February 1971, Poynter to RMT. 38 R.M.Titmuss,‘The Culture of Medical Care and Consumer Behaviour’, in F.N.L. Poynter (ed), Medicine and Culture, London,Wellcome Institute of the History of Medicine, 1969, pp 133–​5. 39 ‘Discussion’ in Poynter (ed), Medicine, pp 161, 162, 168, 169. 40 ‘Fabian Attack on US Market in Blood; Contrast with Britain’, The Daily Telegraph, 6 February 1967, p 19. 41 M. Seldon, letter, ‘Shortage of Blood Supplies’, The Daily Telegraph, 17 February 1967, p 16. 42 TITMUSS/​2/​248, cutting from New Society, 9 February 1967, p 187. 43 R.M. Titmuss, Choice and the ‘Welfare State’, London, The Fabian Society, 1967, pp 13–​16. Reprinted in Commitment to Welfare. 44 LSE/​Staff File/​Titmuss, letter, 6 December 1967, RMT to Waddilove. 45 L. Waddilove, Private Philanthropy and Public Welfare, London, George Allen and Unwin, 1983, pp 96, 125. 46 TITMUSS/​3/​350, letter, 26 October 1966, RMT to Gordon McLachlan, Nuffield Provincial Hospitals Trust. 47 TITMUSS/​3/​350, letters, 21 December 1966, RMT to BrianYoung,The Nuffield Foundation, and 19 December 1966, RMT to Reddin.

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Healthcare, the market, and the Institute of Economic Affairs 48 TITMUSS/​3/​350, letter, 22 March 1967, RMT to K.W. Blyth, The Nuffield Foundation. 49 TITMUSS/​3/​350, letters, 11 April 1967, RMT to N.H. Hayes, Ministry of Health, and 11 May 1967, RMT to Caine. 50 R.M. Titmuss, The Gift Relationship: From Human Blood to Social Policy, London, George Allen and Unwin, 1970, p 5. 51 TITMUSS/​3/​350, letter, 23 May 1968, RMT to Blyth. 52 TITMUSS/​7/​77, letter, 14 March 1967, RMT to Miller; on the William Volker Fund, E.W. Kitch, ‘A Remembrance of Law and Economics at Chicago, 1932–​ 1970’, Journal of Law and Economics, 26, 1, 1983, pp 180–​81. 53 M.H. Cooper and A.J. Culyer, The Price of Blood: An Economic Study of the Charitable and Commercial Principle, London, IEA, 1968, pp 6, 3. 54 Ibid, pp 9, 32n2, 15–​16, 41–​5. 55 LSE Department of Social Policy Project, Oral History Project, Professor Julian Le Grand interviewed by Sonia Exley, 7 February 2013. 56 TITMUSS/​AO, letter, 16 January 1968, RMT to Stevens. 57 TITMUSS/​AO, letter, 21 April, 1969, Medley, Field Fisher and Co, to Furth. 58 TITMUSS/​2/​270, ‘The Gift Relationship and Social Policy –​Notes for Israel December 1969’, pp 1–​4 (caps in original). 59 TITMUSS/​2/​248, letters, 27 July 1970, Gough to RMT, and 30 July 1970, RMT to Gough. 60 TITMUSS/​AO, memorandum, 30 January 1970,Vivian to RMT. 61 TITMUSS/​AO, letter, 28 September 1972, Furth to RMT. 62 R.M. Titmuss, The Gift Relationship:  From Human Blood to Social Policy, New  York:  Pantheon Books, 1971. Later editions include that co-​edited by A. Oakley and J. Aston, R.M. Titmuss, The Gift Relationship, New York, New Press, 1997; and R.M. Titmuss, The Gift Relationship, Bristol, Policy Press, 2018. References here are to the first, English, edition. 63 TITMUSS/​2/​248, catalogue, Pantheon Books: Fall 1970, p 13. 64 R.M. Titmuss, ‘Why Give to Strangers?’, The Lancet, I, 1971, p 125. 65 TITMUSS/​7/​79, letter, 10 March 1971, Mavis Airey,Thames Television, to RMT. 66 R. Titmuss, ‘The Gift of Blood’, Trans-​action, 8, 3, 1971, p 62. 67 TITMUSS/​AO, letter, 3 January 1973, Israel Katz to Titmuss, accepting the latter’s preface. 68 Titmuss, The Gift Relationship, pp 5–​6, 11, Appendix 7, pp 320–​23, and Appendix 3, p 267. 69 Fontaine, ‘Blood, Politics, and Social Science’, p 419. 70 Titmuss, The Gift Relationship, pp 72, 211, 198, 239. 71 COHEN, box 235, folder 7, letter, 17 February 1971, Cohen to RMT. 72 Anonymous, but H. Barnett, ‘Altruism Rediscovered’, The New England Journal of Medicine, 11, 284, 1971, pp 612–​13. 73 TITMUSS/​AO, letter, 15 April 1971, RMT to Barnett. 74 TITMUSS/​AO, letters, 1 July 1971, Amey Havey, Director, Blood Program, American National Red Cross, Greater Hartford Chapter, to RMT, 3 August 1971, RMT to Havey. 75 D. Owen, ‘Blood Money’, New Statesman, 22 January 1971, pp 118–​19. 76 M. Meacher, ‘To the Last Drop of Blood’, Tribune, 12 February 1971, p 6. 77 F. Lafitte, Journal of Social Policy, 1, 1, 1972, pp 81–​4. 78 A.J. Culyer, ‘Quids without Quos: A Praxeological Approach’, in The Economics of Charity, London, IEA, 1973, pp 45, 48, 41.

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RICHARD TITMUSS 79 Jackson, ‘Richard Titmuss’, pp 148–​9. 80 R. Locke, ‘Of Blood and Human Society’, The New  York Times, 13 March 1971, p 27. 81 ‘Seven Books of Special Significance Published in 1971’, The New York Times, 5 December 1971, p BR2. 82 TITMUSS/​3/​350, clipping from The Lancet, December 1971. 83 E.W. Browne Jr and G.E. Clifford,‘The Blood Business: Bad Blood, Bad Business, Bad Book’, The Washington Post, 12 March 1971, pp B1, 5.

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28 ‘It really is hell’: disruption at the LSE Introduction The 1960s saw student unrest across Western Europe and North America, and the LSE was one of the main British participants by way of what came to be called ‘The Troubles’. Titmuss did not approve. In April 1969 his old friend Margaret Gowing, now at the University of Kent, hoped that ‘things aren’t as bad as they sound for you but I fear they probably are. It must be hard with departments and friends on different sides etc: presumably a complete civil war. I am sorry’.Titmuss replied that at ‘the moment most of us here are living from hour to hour –​it really is hell’.1 The following month it was announced that David Donnison was leaving, as The Times put it, the ‘embattled LSE’, to take up another post. Donnison admitted to ‘feeling like the proverbial rat leaving the sinking ship’. But the School had not become ‘a more attractive place to work recently’, and he only wished that he ‘was leaving when morale was higher’.2 What was it that reduced Titmuss, and Donnison, to such despair?

Titmuss and students Titmuss was justly famed for taking considerable care of his students at a time when this was not necessarily the norm in British higher education. While he could be disparaging about their middle class backgrounds, on a personal level he was kind, attentive, and supportive, and devoted to education in all forms. During his final illness, although in considerable pain, he went out of his way to maintain his teaching commitments as best as he could. In the October preceding his death, he told his second year students that he had been ‘deeply touched by

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those lovely flowers’ he had discovered on his return from yet another hospital stay. He would be back with them as soon as possible, and would share his experiences of the NHS.As well as having ‘hobnobbed’ with other patients, he had even been ‘allowed to have a seminar with students –​nurses and medicare!’3 Such recollections were to form the basis of the Postscript to the posthumously published Social Policy: An Introduction.4 A number of interviewees for this volume likewise attested to Titmuss’s positive engagement with them when graduate students in the department.5 And while we perhaps remember the addresses at Titmuss’s memorial service by the likes of Crossman, it is worth recalling that a student, Sally O’Brien, also spoke.6 All this suggests a genuine, and reciprocal, affection between Titmuss and many of his students. His attentiveness could sometimes have superficially rather bizarre dimensions. One student in Titmuss’s department in 1965 was Princess Margrethe, future Queen of Denmark. A longstanding acquaintance, Henning Friis of the Danish National Institute of Social Research, told Titmuss that it had been ‘a great pleasure to visit you and Kay and to meet your daughter and her husband’. Another guest was Margrethe whom Friis had been pleased to meet ‘in an informal way’. It was to be hoped that ‘she will keep an interest in youth problems’ on her return home, ‘and that she will pay a visit to our Institute some day in order to be acquainted with this part of Danish life’.7 A few months later, the Danish journal Politiken recorded that a ‘small “downpour” of orders descended last night’ on leading members of the LSE. Margrethe, a ‘grateful student’, had persuaded her father to have the Danish ambassador in London confer the award of Commander of the Order of the Dannebrog on Caine and Titmuss, while Kit Russell and Christine Cockburn, two of the department’s tutors, were made Knights of the Order of the Dannebrog.8 Dating from the seventeenth century, the chivalric Order of the Dannebrog was in the gift of the Danish monarch, and awarded for meritorious service to Denmark. Titmuss later told Lionel Robbins, chair of the School’s governors, that he, Russell, and Cockburn had taken responsibility for the princess’s visit, and devised a daily schedule of activities.9 Margrethe clearly did not forget Titmuss for on his death the ambassador, in a letter passed on to Kay, wrote to Walter Adams to express Queen Margrethe’s ‘condolences on the loss the London School of Economics has suffered through the death of Professor Richard Titmuss’. While still heir to the throne, Margrethe had ‘attended [in  1965] a course at the School and received much valuable guidance from Professor Titmuss’.10 Titmuss’s support for Margrethe might be seen as yet another instance of his soft spot for aristocratic women, and no doubt its senior

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management saw such visits as contributing to the School’s prestige. But it also shows Titmuss as genuinely concerned with the wellbeing of a young person for whom he had taken personal responsibility. It is notable, too, that he defended students in much more distressing circumstances than those at the LSE would ever have encountered. He was, for instance, party to a letter in November 1968 condemning the persecution of Jewish students in Poland.Titmuss and his co-​signatories, who included Donnison and the Marxist historian Eric Hobsbawm, thus publicly associated themselves with the impending ‘International Day of Protest against Student Trials in Poland’, appealing to ‘world opinion’ to protest at their predicament.11 Titmuss’s almost unfailingly positive relationship with students as individuals, and his concern for beleaguered student populations, is emphasised because the stance he took during ‘The Troubles’ was not motivated by hostility towards undergraduates and postgraduates. What did offend him, though, was what he perceived as a threat to an institution about which he grumbled a lot but to which he was, ultimately, loyal. Titmuss was critical, too, of what he was to describe as an adherence to ‘over-​simplified theories’, whether promoted by students or fellow staff members, at the expense of evidence and historical understanding.And he was likewise antipathetic to what he saw as bullying and threats to academic freedom.

A new director In June 1965, and a sign of his senior standing in the School, Titmuss was appointed to the committee charged with finding a replacement for Sydney Caine, who had intimated that he would stand down in July 1967.12 As Tessa Blackstone and her colleagues made clear in their report into the LSE in the late 1960s, its administrative structures and processes were, at this point, hardly a model of clarity, while students had little say in the running of the institution. As they further remark, it was thus ironic that the procedure to find a replacement for Caine ‘involved more consultation and participation than the appointment of any previous Director’, although consultation, rather than participation, was the order of the day, something which, again, did not extend to students.13 After much discussion, a candidate was found in Walter Adams, Principal of the University College of Rhodesia, and former School secretary.Adams was offered the directorship with effect from October 1967. This proved a controversial choice. As we saw in Chapter 26, Rhodesia had unilaterally declared independence in November 1965

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in order to maintain its racially discriminatory regime  –​that is, in the middle of the deliberations of the committee on which Titmuss sat. Left-​wing LSE students, already concerned about the Rhodesian situation, picked up on Adams’s purported failings in dealing with that country’s rulers, and the case was taken up by the Student Union. This led to a standoff between the Student Union and the School, which was resolved relatively amicably, although at one point students boycotted lectures. Divisions were also emerging among the academic staff, however, and these came into the open at an acrimonious meeting of the Academic Board in November 1966.Titmuss was among those defending Adams’s appointment. As Dahrendorf records, after ‘four hours of discussions the Board rose, no doubt in a state of confusion and much unhappiness’.14 The issue flared up again in early 1967, with Caine refusing students access to the Old Theatre, where a meeting to discuss how to block Adams’s appointment had been planned.This was the occasion of the death of one of the LSE’s porters. Partly in consequence, although the unfortunate porter was known to be unwell and it was generally accepted that nobody was directly responsible for his death, disciplinary proceedings were instituted against student leaders. Boycotts and sit-​ins, lasting over a week, ensued. As a result of these upheavals Titmuss drafted a letter to The Times which does not appear to have been published, but does give an insight to his thoughts at this time. Headed ‘A student is a student is a student’, he suggested that there was ‘much more to be said on the subject of the responsibilities of teachers and students in our universities today’ than it had been possible to deal with in the newspaper’s recent editorial. But before ‘too many letters of generalisations’ were drawn about recent events,‘account should be taken of certain facts’ about its student body’s composition. In particular, the number of postgraduates and undergraduates from the USA had more than doubled over the last ten years, and now outnumbered those from the ‘developing countries of the Commonwealth’. Overall, they constituted some 10 per cent of the student population. So while staff/​student relations were ‘in no way comparable with the unhappy experiences of the Berkeley Campus’, nonetheless some students conceived of Berkeley as ‘a “model” for student behaviour’. Other factors were also involved, not all of which were the student body’s fault. Understanding the School’s problems, therefore, was ‘a joint responsibility and one that should be accepted before we rush to judgement on the young’.15 Berkeley, part of the University of California, was the famously turbulent campus where, throughout the 1960s, protests took place over issues such as Vietnam, some resulting in violence. Titmuss’s comments on the

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student body’s changing membership are illuminating in that, in later phases of ‘The Troubles’, American graduate students played a prominent role.The reference to students from the ‘developing countries of the Commonwealth’, meanwhile, reflects both Titmuss’s engagement with Africa around this time, and that a number of such students were taught in his department.

More problems and bad publicity The disruptions of early 1967 seemed, though, to have calmed down by the spring, and a period of relative quiet followed. Adams, the initial cause of the unhappiness, took up his directorship without any problems. However, wider events again intervened, and what had previously been, at heart, a problem of accountability and student discipline gained a broader dimension. Demonstrations against the Vietnam War took place in Central London in autumn 1968, and student activists wanted the LSE’s facilities to be available to protestors. Despite opposition from the LSE leadership, this went ahead. But matters continued to escalate, with activists throwing the situation in Rhodesia, and apartheid South Africa, into the mix. In a spectacularly inept move, School management decided to install gates at various points throughout its estates.This did nothing to allay student suspicions about the direction in which the administration sought to move. The gates were attacked, and in January 1969 the director decided to close the LSE indefinitely, in the event for 25 days. When the School’s main buildings were closed,Titmuss’s initial reaction was that the department should suspend teaching. But Abel-​Smith, although taking a much more conciliatory line over rebellious staff and students, insisted that teaching carry on, and Skepper House proved a home away from Houghton Street when required.16 Again staff were divided over these events, some making common cause with the student activists. Among the many unhappy outcomes was that two academics, Nicholas Bateson and Robin Blackburn, had their contracts terminated. By the summer of 1969, though, peace had finally broken out. These various upheavals did the LSE no favours in terms of publicity and reputation.17 In February 1967 The Times reported a statement, signed by around half the academic staff, which condemned the attacks on Adams, and ‘the violence to which they have led’. This, the article maintained,‘clearly referred to the disturbances at the school on Tuesday in which a porter died’.The staff ’s statement also argued that attacks on the director were ‘contrary to the spirit in which the affairs of the school should be conducted and a potential threat to academic freedom’. Many

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of the signatories were ‘internationally famous names’, such as Titmuss, and the philosopher Michael Oakeshott.18 That this piece appeared on the newspaper’s front page illustrates the media attention engendered by the disruptions. And, for those in the know, the conjunction of Titmuss and a political opponent such as Oakeshott (encountered in Chapter 1 as referring to Titmuss as a ‘snake in saint’s clothing’) must have brought the expression ‘strange bedfellows’ to mind. But staff attitudes to ‘The Troubles’ blurred conventional political lines. In February 1969, The Observer reported that the ‘hardliners’ taking a pro-​administration stance were not all politically right wing. There were also ‘orthodox Labour’ figures such as the industrial relations expert Professor Ben Roberts. Even further from the political right was Titmuss, albeit ‘a less orthodox Labour man’. Essentially, the division was between the ‘tough-​minded and the tender-​minded’.19 A week later, the same newspaper ran a piece on the School’s history. In the 1930s it had been a ‘haven of good conduct’, but was now a ‘byword for disorder’. It was generally agreed that decline had set in, although while ‘the old names have gone, it still has giants, like Sir Karl Popper and Professor Richard Titmus [sic]’.20 That a broadsheet Sunday newspaper should run such articles on two consecutive weeks again shows the broader impact of ‘The Troubles’. Colleagues from outside the LSE came to Titmuss’s support. For instance, in May 1969 Cyril Bibby, Principal of Kingston-​upon-​Hall College of Education, leading health educator, and former Labour Party parliamentary candidate, wrote to Titmuss. The two had known each other since the 1930s through the Eugenics Society.21 Bibby had been impelled to get in touch by an article in that day’s Observer. ‘Thank goodness’, he wrote, that ‘at least one LSE professor has the guts to take a firm stand against the student neo-​fascists’. Some students certainly had legitimate grievances, and in dealing with these many vice-​chancellors had been ‘incredibly ham handed and … spineless’. But ‘some of the so-​called “revolutionary socialists” were not socialist at all, but neo-​fascist’. Titmuss, thanking Bibby for his letter, claimed that at ‘times like these such support is indeed welcome’.22 Unsurprisingly, the School’s problems disrupted Titmuss’s work.We noted in the previous chapter that 1969 saw him turning down many invitations, attributing this to the situation at the LSE. Apologising to Anthony Lester, in May 1969, for his delay in replying to a letter, he told him that ‘I can’t help being involved in the LSE!’23 On the same day, Titmuss wrote to his colleague, Hilary Land, thanking her for her draft manuscript. It would, though, be ‘some time before I can get round to reading it as I am at the present time overwhelmed with responsibilities at the School’.24

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Titmuss’s take on ‘The Troubles’ Addressing the School of Social Work in Jerusalem in April 1967, Titmuss remarked, no doubt tongue in cheek, that his audience might be aware of the recent unrest at the LSE, which was the leading British university concerned with ‘the social (or behavioural) sciences’. The unrest had thus been a ‘painful experience’, and ‘especially humiliating for those faculties who claim some competence in the understanding of human beings in social situations’.The causes of this ‘student revolt’ were complex, but partly stemmed from the ‘populist demand’ for students’ rights. In turn, this was, to some degree, attributable to the ‘neglect of teaching’ in ‘some subjects and in some faculties’. Titmuss clearly felt this was a legitimate complaint, symptomatic of the tendency of many academics to see their ‘real’ work as research, not teaching.The expansion of higher education had also resulted in more, and more diverse, students, only to be taught by staff hired for their research, rather than their pedagogic, skills. Society thus had to ask itself what was the purpose of universities, and expenditure upon them, while continuing to guarantee academic freedom. Universities should also have ‘welfare objectives’, including that of ‘social integration’. For Titmuss, higher education’s role was not to ‘legitimate (and thus increase) class and ethnic divisions in society’ –​on the contrary. There was, therefore, a pressing need for more children from the working class, and from ethnic minorities, to take up higher education. Left to their own devices, universities would not meet this challenge. Therefore, ‘special educational policies’ were required to equalise opportunity.25 This was a thoughtful piece, with Titmuss acknowledging that students had justifiable grievances, especially about teaching standards. He was not prepared to spare his professional colleagues in this respect. So when receiving an honorary degree at the University of Toronto in 1965, he told his audience that good teaching should be valued, and that a better balance needed to be struck between ‘the “publish-​or-​perish” school and the contribution of the good teacher’.26 And shortly before his death, Titmuss told a correspondent that ‘we are living in an age of arrogance –​particularly the academics who need, more than most, a leavening of humility in their teaching and writing’.27 So here was another instance of ‘welfare professionals’ pursuing their own interests at the expense of those whom they should be serving. Current access to higher education, meanwhile, was another example of social inequality. Titmuss picked up the last point in his preface to a work on educational inequality, published in 1969, which he described as in ‘the tradition of Tawney in combining both a sense of fundamental values

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and a grasp of the practical and detailed problems involved’ –​praise indeed.The book also acknowledged the complex relationship between educational inequalities and what he termed ‘environmental inequalities’.These brief comments are interesting in themselves but, for present purposes, especially notable is Titmuss’s argument that ‘There was a time when the English were so oppressed by the weight of history and historical determinism that they found it difficult to comprehend the possibility of effecting change in the economic and social order’. But things had changed. Pessimism went ‘deeper –​especially among the young –​because inequality cannot be abolished next Monday’. They found it difficult to work ‘within a slowly moving political system’, which might only produce results in the longer term. How could this be explained? One of the ‘many contributory factors’ in an era of rising expectations was the ‘substitution of over-​simplified social theories for the study of history; of how men comprehend the complexities of power and the stubbornness of institutions’ in order, ultimately, to improve the human condition. Titmuss conceded that these might be ‘irrelevant thoughts’, although he almost certainly did not believe this. In any event, he was led to them ‘in reading the proofs at a time when, sadly, the police surrounded the London School of Economics’.28 It would be foolish to over-​read such a brief statement, but it does give some hints as to how Titmuss felt about ‘The Troubles’. Without spelling it out, Titmuss was aware of the irony that the beneficiaries of an educational system characterised by inequality were themselves protesting about injustice. They were doing so using ‘over-​simplified’ social theories, an argument which must surely be seen as a critique of the Marxism espoused by many LSE activists, and more generally of the intellectual ambitions of, especially, sociology. As Mathew Grimley points out, student disturbances at institutions such as the LSE and the University of Essex were often attributed, rightly or wrongly, to sociology staff and students.29 For Titmuss, though, such abstract thought was deployed at the expense of historical understanding, and the associated acknowledgement that change did not arrive overnight but, rather, resulted from slow, painstaking, work. Although ‘Titmuss as a Fabian’ is problematic, elements of the classic Fabian approach can be discerned here. A further episode in ‘The Troubles’ took place in late 1968. It is not possible to identify any direct involvement by Titmuss, but aspects of it must have pleased him. As Dahrendorf records, the LSE’s ‘uneasy quiet’ was again disturbed on 5 December when the historian Hugh TrevorRoper delivered its annual oration. For the student rebels,Trevor-​Roper was associated with the military junta then controlling Greece, and so

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they occupied supposedly reserved seats in the Old Theatre.Thanks to skilful handling by Lionel Robbins, the situation was defused, although effectively this was a defeat for the students.30 Trevor-​Roper told his audience that he had been invited by the director, and left free to choose his topic.Trevor-​Roper was not the darling of the liberal left, so Adams’s invitation is, in itself, intriguing. As to his subject matter, this was ‘The Past and the Present: History and Sociology’. There were those who dismissed the need for historical understanding, preferring analysis of contemporary society, or who saw history as merely a form of entertainment (a jibe at the popular historian, A.J.P. Taylor). Consequently, ‘graver persons come and bid us turn our serious attention to the new queen of sciences, sociology’. Unsurprisingly,Trevor-​Roper disagreed, and ‘here, in this home of sociology, I shall venture to defend my disagreement’. Having subtly belittled the discipline of sociology, he then defended history, and historical method. While not an exact science, history nonetheless required close attention to evidence, along with a recognition of the complexity of human experience. If the rules of historical method were scrupulously followed, studying past events might prove to be ‘not only interesting but useful’. Understanding the historical past might result in a greater understanding of the present and, thereby, the potential to improve contemporary society.31 Titmuss and Trevor-​Roper were hardly soulmates, but for the former the public defence of the method he routinely employed, and the dismissal of sociology, must have been music to his ears. The disruptions at the School, though, undoubtedly both infuriated and upset Titmuss. One episode especially illuminates key aspects of his hostility to ‘The Troubles’ and what, for him, they represented. In spring 1969 the deputy academic registrar asked him to report on the experience of Professor Alan Day, known as a LSE ‘loyalist’, when he had recently attempted to deliver a lecture Titmuss had attended. Titmuss agreed, noting that he had been ‘appalled by the behaviour of a number of the students present’. There had been a clear, deliberate, attempt to prevent Day from speaking.When the latter had given up,‘I would have thought [by what] was sheer physical exhaustion’,Titmuss, and the Psychology Professor Hilde Himmelweit, had unavailingly ‘attempted to reason with the crowd’.32 In a further intervention around this event, Titmuss wrote to the soon to be sacked Robin Blackburn. Blackburn, Titmuss reminded him, had published one of his essays, and they had met on a couple of occasions. On the strength of this (somewhat tenuous) relationship,Titmuss appealed to his colleague. He had attended Day’s lecture, and what he had witnessed ‘appalled me’. When Day had been forced to give up, he and Himmelweit had, on

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attempting to address the students, been ‘shouted down’. His previous experience of such behaviour had been ‘in the East End of London in the 1930s when I tried to speak against the Mosley invasion’. As a socialist, he had no need to emphasise to Blackburn, a fellow socialist, ‘my belief in freedom of speech and freedom of conscience’. He thus asked Blackburn to ‘use all the influence you have to help us preserve these freedoms at the School in these difficult times’.33 There was almost certainly a generational effect here. It is notable that Bibby referred to the student activists as ‘neo-​fascists’, and that Himmelweit, Titmuss’s fellow interventionist, was a refugee from Nazi Germany. As noted in Chapter 3, Titmuss’s Mosley reference alludes to his part in the resistance to the fascist Blackshirts’ attempt to parade in a heavily Jewish part of London’s East End. For such individuals, the realities of fascism and intolerance were lived experience. In yet another expression of his dismay at what had happened at the School, a few weeks after the Day incident Titmuss responded to an article on the LSE’s problems by his colleague David Downes, published in Peace News.Titmuss told Downes that had the latter been at a recent staff meeting ‘you would have learned something about my feelings concerning both staff and students and what the recent “troubles” have meant to me’. Titmuss’s plans for a new course in ‘Community Relations’ had been subverted by the disruptions, much to his annoyance and grief, and in his present state of mind he was disinclined to comment on Downes’s article, except on one particular point. The latter had asserted that the School was, and had been, ‘profoundly authoritarian’. By what criteria had Downes made this claim? Was he, for instance, comparing the LSE with universities in Britain and elsewhere? In a weary final note, but one not without an edge, Titmuss suggested that he would be ‘interested to know because, in approaching retirement, I am still not clear how we combine “academic freedom’ with decision making in the allocation of resources and the maintenance of standards of teaching and research’.34

Interpreting ‘The Troubles’ ‘The Troubles’, as we have seen, attracted much publicity, and were to be the subject of much analysis and debate. Among the sources drawn on here so far are Dahrendorf ’s history of the School, and the Research Monograph by LSE staff, two of whom were attached to the Statistics department while the other two, Tessa Blackstone and Roger Hadley, were in Titmuss’s own department.Accounts from a student participant perspective can be found in, for example, the book by Colin Crouch.

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The latter noted that in 1965 Titmuss had contributed to a book edited by Robin Blackburn and Perry Anderson, prominent members of the ‘New Left’. As Crouch tartly remarked, it seemed unlikely Titmuss and four of the other contributors ‘would now appear together in one volume’.35 Titmuss had, of course, appealed to Blackburn partly on the basis of his essay. Especially noteworthy for present purposes, though, is Harry Kidd’s book, published in 1969. Kidd had been LSE secretary between 1954 and 1967, and a major player when ‘The Troubles’ flared up. He appears to have been a controversial figure, with Dahrendorf noting that opinion about him varied widely. For some he was deeply anti-​student, while for others he was a model of rectitude. But he undoubtedly took ‘the trouble of 1967 very seriously’, particularly over disciplinary matters.36 What is significant with regard to Titmuss is that, when Kidd came to write his book, he was among those sent draft chapters. These arrived during the second wave of unrest, that is in 1968/​69, and thus had both historic and contemporary resonances. Titmuss commended Kidd on his efforts, noting in late 1968 that he had been ‘absorbed by this and (in the midst of our present troubles) found it hard to put aside’. The draft was ‘most elegantly written (a model for many academics) with a judicious blend of wit, tolerance and firmness’. The book would, it was to be hoped, appear soon, for it could ‘only do good –​not only for the LSE but for other universities and colleges’.37 What was it about Kidd’s volume that so impressed Titmuss? Kidd admitted that he could not ‘pretend to be dispassionate’, for the School had meant a lot to him, and many friends had been involved in its upheavals. He quoted passages from Titmuss’s Jerusalem speech to the effect that, first, academics were largely free to choose their hours of work and that this was essential to academic freedom. Second,Titmuss had suggested that this very freedom militated against institutional self-​criticism. Kidd unreservedly agreed with the latter position, but was more sceptical about the former. The ‘idle minority’ who took advantage of academic freedom was relatively small, but did disproportionate damage.38 As a senior administrator, Kidd no doubt had plenty of opportunity to observe academic slacking. But we know, too, that Titmuss was aware of the dilettante tendencies of some of his colleagues. Perhaps the most intriguing of Kidd’s chapters is that on student discipline, and here we have Titmuss’s commentary on some of the issues Kidd raised.Three suffice to make the point. First, Kidd repudiated the idea that in higher education ‘the piper should pay the tune’ –​that is, that either the state or student ‘consumers’ should determine curriculum content. This was fundamental to academic autonomy, with

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university staff being paid to ‘exercise independence of judgement, to be original’. Second, Kidd claimed to find an ‘anti-​academic strand in current student thought’ manifested by, for example, the idea that education was simply about the communication of a large volume of ‘factual information’. Third, returning to the question of academic autonomy, Kidd cited the experience of the philosopher Imre Lakatos, an LSE colleague. Lakatos had fled communist Hungary in 1956, and written, from personal experience, of the suppression of academic freedom under both Nazism and Stalinism. He had further suggested that some of the positions adopted by elements within the LSE Students’ Union could have been taken directly from the propaganda employed during the ‘Cultural Revolution’ presently taking place in communist China. Kidd clearly agreed, further noting the trend at some American and British universities to stop academics researching in areas of which students did not approve,‘a usurpation of a decision that belongs to their teachers and to them only’.39 Titmuss, in his handwritten comments on a letter from Kidd, noted respectively ‘Consumer is king’, ‘The unacademic strand in students’, and ‘Nazism of students’.40 Once again, it would be absurd to over-​read such potentially ambiguous emendations. But if they were indeed approving of what Kidd had written, this would by no means be inconsistent with Titmuss’s views.

Titmuss, Townsend, and ‘The Troubles’ Titmuss’s stance at the LSE also further contributed to the deterioration of his relationship with Peter Townsend. As we saw in Chapter 25, this was already under severe strain because of the latter’s criticisms of the Labour government’s social policy, and Titmuss’s involvement with the SBC. A particularly low point had come about in autumn 1968, so it is worth pausing here to look further at their growing apart.41 The University of Essex had been founded in 1963, part of the contemporary expansion of higher education. In March Townsend told Titmuss of Essex’s offer of a Chair in Sociology. Initially, he had been inclined to reject the approach, being reluctant to ‘contemplate any form of separation from yourself and Brian, to break up a “federation” or team which is stronger than the sum of the strengths of the individuals belonging to it’. He had likewise been reluctant to risk losing time on existing research projects, and acknowledged the powerful arguments for ‘maintaining the strength and influence of the Titmuss department and of the LSE –​both in relation to other universities as well as the Labour Party’. However, he was now beginning to change his mind. Essex was a new university, with ambitions

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to be second only to the LSE in Sociology, Social Psychology, and Social Administration. Senior figures there held ‘at least some of the values I feel would be necessary in the planning of all this’. Here he specifically named Noel Annan, the economist Richard Lipsey, formerly of the LSE and Essex’s first Dean of Social Studies, and the founding Vice-​Chancellor, Albert Sloman. Townsend had ensured that funds were committed for research, ‘as you have taught me’. Of course, things might go wrong, and it was ‘highly unlikely’ that any department he might develop would be ‘so incredibly free of personal acrimonies as yours (which many people know is really due to your greatness)’. Townsend was clearly going to take the post, but equally clearly nervous about Titmuss’s reaction.Titmuss had been ‘one of the most important influences of my life and work. I owe more to you than you will know’. So he had the ‘uneasy feeling that if I decide to accept the chance of going to Colchester, and they finally decide to have me, you will be disappointed in me’. This was why he had been ‘tongue-​tied on the phone on Saturday’. But ‘I hope to go on learning from you –​all my life –​for that is very precious’.42 Two points are worth making here. The first concerns Townsend’s recruitment to Essex, and the nature of that institution. Sloman had set out his vision of Essex as a place where the ‘social sciences [were] at the heart of the academic structure’. He was completely open about his recruitment methods.While, in general, British academic posts were publicly advertised, this was not the case with the first Essex professors. These had to be ‘leaders in their field, men of intellectual distinction with the promise of really original work’. Once identified, such individuals had been approached directly, as had been the case with Townsend. Perhaps with Townsend in mind, Sloman acknowledged that they had found ‘some academic people who were reluctant to leave an active research team’, but for those who accepted there was the compensation of being in on something new and innovative.43 In a later interview,Townsend stressed that he saw a ‘huge opportunity both for Sociology and for Social Policy’, a point he had made to Titmuss. But, in a revealing passage, he also criticised the LSE as ‘poorly managed and very unimaginative and uncreative’. This is a rather different picture to that he had given Titmuss some years earlier, at least in respect of their own individual, and collective, activities. By contrast, what Mike Savage describes as the ‘radically different kinds of academic values from those found in the older universities’ characteristic of the so-​called ‘plateglass universities’ were clearly, as far as Townsend was concerned, hugely appealing.44 Thus both pull and push factors were involved in Townsend’s decision, and it is hard to see Titmuss approving of either.

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Second, in his highly emotional letter Townsend seems to see Titmuss in an almost filial light. Was it significant that Townsend’s own father had abandoned him, and his mother, early in his childhood? Equally, was it significant that, by Oakley’s account,Titmuss had wanted a son, but gained a daughter?45 Whatever the origins of these emotional dynamics, Titmuss was indeed ‘disappointed’ by Townsend’s move. Apart from any other consideration, he was losing a close colleague and friend, of whom he had been extremely supportive, with Titmuss appearing to construe Townsend’s move as a betrayal.46 Oakley records that Townsend’s letter was followed by a ‘very uncomfortable meeting’ between the two men at Titmuss’s home, at which Titmuss attempted to talk his young colleague out of his decision.47 Titmuss had, more broadly, reservations about university expansion as implemented in the 1960s. What the Robbins Report of 1963 had recommended, he claimed in his 1967 Jerusalem speech, was ‘an extension and expansion of elitist education’, and he commended the Labour government for its strategy of encouraging the other part of Britain’s tertiary education sector, the polytechnics and technical and vocational colleges.48 And we also noted, in Chapter 26, his 1971 lecture in which he disparaged ‘the Oxbridges and the lush campuses of Canterbury, Essex etc’, the last point almost certainly a jibe at Townsend. All this is of a piece with his critique of higher education, and its students, as a middle class stronghold. One of the unsurprising facts which Blackstone and her colleagues uncovered when looking into ‘The Troubles’ was that only 20 per cent of LSE students came from homes where their fathers were manual workers.49 To return to student unrest of the late 1960s, which affected not only the LSE but also other institutions, including Essex, in spring 1968 Abel-​Smith sent Titmuss a cutting from the London newspaper the Evening Standard which attributed certain comments to Townsend. This prompted a response from the latter in the form of a letter to Abel-​Smith,Titmuss, Crossman, Peter Shore, and Shirley Williams.The piece was,Townsend claimed, a ‘travesty of what I in fact said and contrary to reports in the rest of the press’. Whatever was in the Evening Standard article,Townsend was anxious to make his own position clear. But this was not one which would necessarily endear him to Titmuss. By Townsend’s account, the Essex authorities had acted badly over the suspension of three students although, he conceded, the former were now attempting to modify their behaviour. Nonetheless, the disciplinary action had not been properly explained, causing ‘moderate’ students to take action.The egalitarian ideals which Essex had originally cherished were coming into conflict with the hierarchical structure which it had

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developed post-​1963.50 At the top of this hierarchical structure was, of course, Albert Sloman, in whom Townsend had placed his faith a few years earlier. To add a further twist to this story, Oakley records that when Blackburn lost his job at the LSE, Townsend sought to recruit him to Essex only for this to be vetoed by Sloman.51 If Titmuss was aware of this, it would surely have further alienated him from Townsend.

Conclusion The question remains why Titmuss took the stance on ‘The Troubles’ he did. For some, it was evidence of his move politically rightwards.52 Hilary Rose, an LSE student during ‘The Troubles’, later a member of staff, came to ‘see Titmuss as always compassionate’, but nonetheless ‘elitist and deeply undemocratic’.53 Another former colleague interviewed for this volume stressed just how hostile Titmuss was to the students’ arguments, and how his preferred means of resolving LSE issues was through bureaucratic manoeuvring.54 Others dispute such judgements.55 We have seen, too, that by the late 1960s colleagues such as Townsend had come to view Titmuss as part of the ‘Establishment’. What is evident, though, is that Titmuss was an LSE loyalist who, by this stage of his career, was influential within it. He was clearly disturbed by student activism, what he saw as the deleterious influence of abstract ‘theory’, and by perceived threats to academic freedom. Little wonder, then, that he often gave off a sense of despair, and exhaustion.Titmuss’s take on the LSE in some of its darker days will be another factor for consideration when assessing his life and career. Notes 1 TITMUSS/​7/​77, letters, 24 April 1969, Gowing to RMT (emphasis in original), and 29 April 1969, RMT to Gowing. 2 LSE, LSE/​Small LSE Deposits/​144, press cutting, ‘Quitting LSE’, The Times, 3 May 1969. 3 TITMUSS/​AO, letter, 16 October 1972, RMT to second year students, Department of Social Administration. 4 R.M. Titmuss (ed B. Abel-​Smith and K. Titmuss), Social Policy: An Introduction, London, George Allen and Unwin, 1974, pp 145–​51. 5 I am grateful for the recollections of Professors Jose Harris,Adrian Sinfield, and Pat Thane interviewed, respectively, 18 July 2016, 9 January 2016, and 9 March 2016. 6 COHEN, box 235, folder 7,‘Professor Richard Morris Titmuss: A Thanksgiving’. 7 TITMUSS/​2/​115, letter, 19 June 1965, Friis to RMT. 8 TITMUSS/​AO, translation of article in Politiken, 21 October 1965. 9 TITMUSS/​7/​80, letter, 9 March 1972, RMT to Robbins. 10 LSE/​Staff File/​Titmuss, letter, 12 April 1973, Erling Kristiansen to Adams. 11 Letter, ‘Polish Student Trials’, The Times, 27 November 1968, p 11.

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RICHARD TITMUSS 12 The narrative throughout this chapter draws on Dahrendorf, A History, p 443ff; and T. Blackstone, K. Gales and R. Hadley, Students in Conflict: LSE in 1967, London, LSE Research Monograph 5, 1970. 13 Blackstone et al, Students in Conflict, pp 151–​3. 14 Dahrendorf, A History, p 451. 15 TITMUSS/​8/​14, draft letter, 3 February 1967, RMT to The Times. 16 Author’s interviews with Professors Howard Glennerster, 7 October 2015; Pat Thane, 9 March 2016; and Jose Harris, 18 July 2016. Also Sheard, The Passionate Economist, p 248ff. 17 See also the comments on media coverage in Dahrendorf, A History; and Blackstone et al, Students in Conflict. 18 ‘LSE Teachers Condemn Adams Attacks’, The Times, 4 February 1967, p 1. 19 ‘Deadlock at the LSE’, The Observer, 9 February 1969, pp 1, 3. 20 LSE, LSE/​Small LSE Deposits/​144, press cutting, ‘LSE: How it All Began’, The Observer, 16 February 1969. 21 On Bibby, see Oakley, Man and Wife, pp 118, 120. 22 TITMUSS/​7/​77, letters, 11 May 1969, Bibby to RMT; and 15 May 1969, RMT to Bibby. 23 TITMUSS/​4/​564, letter, 22 May 1969, RMT to Lester. 24 TITMUSS/​7/​77, letter, 22 May 1969, RMT to Land.The manuscript in question would soon form H. Land, Large Families in London: Occasional Papers in Social Administration No 32, London, G. Bell and Sons, 1969. 25 Titmuss, ‘The University and Welfare Objectives’, p 26ff. 26 TITMUSS/​7/​73, undated, but 1965, typescript ‘Convocation’, p 3. 27 TITMUSS/​7/​81, letter, 15 January 1973, RMT to William Pierce, Child Welfare League of America. 28 R.M.Titmuss,‘Preface’, in G. Taylor and N. Ayres, Born and Bred Unequal, London, Longman, 1969, pp x–​xi. 29 M. Grimley, ‘You Got an Ology? The Backlash Against Sociology in Britain, c 1945–​90’, in L. Goldman (ed), Welfare and Social Policy in Britain since 1870: Essays in Honour of Jose Harris, Oxford, Oxford University Press, 2019, pp 184–​6. 30 Dahrendorf, A History, p 463. 31 H. Trevor-​Roper, ‘The Past and the Present: History and Sociology’, Past and Present, 42, 1, 1969, pp 3–​4, 17, and passim. The text was also published as a pamphlet by the LSE. 32 TITMUSS/​8/​14, letter, 30 April 1969, G. Ashley to RMT; and letter, 1 May 1969, RMT to Ashley. On Day as a ‘loyalist’, Dahrendorf, A History, p 463. 33 TITMUSS/​8/​14, letter, 30 April 1969, RMT to Blackburn. 34 TITMUSS/​8/​14, letter, 3 June 1969, RMT to Downes; also Oakley, Father and Daughter, p 193. 35 C. Crouch, The Student Revolt, London, The Bodley Head, 1970, pp 16–​17. 36 Dahrendorf, A History, p 458. 37 TITMUSS/​8/​15, letter, 11 November 1968, RMT to Kidd. 38 H. Kidd, The Trouble at the LSE, 1966–​1967, London, Oxford University Press, 1969, Preface, pp 130–​31. 39 Ibid, pp 138–​9, 141, 142–​4. 40 TITMUSS/​8/​15, undated (but presumably autumn/​winter 1968) Kidd to RMT, with handwritten comments by the latter. 41 On Townsend, H. Glennerster, ‘Peter Brereton Townsend’, Oxford Dictionary of National Biograph, Oxford, Oxford University Press, 2004; and H. Glennerster,

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‘It really is hell’: disruption at the LSE ‘Peter Brereton Townsend 1928–​2009’, Proceedings of the British Academy,Vol 172, Biographical Memoirs of Fellows, X, 2011, pp 303–​21. 42 TITMUSS/​8/​12, letter, 14 March 1963, Townsend to RMT. 43 A.E. Sloman, A University in the Making, London, The British Broadcasting Corporation, 1964, pp 19–​20. 44 M. Savage, Identities and Social Change in Britain since 1940: The Politics of Method, Oxford, Oxford University Press, 2010, pp 127–​8, and citing Paul Thompson’s interview with Townsend. 45 See Oakley, Man and Wife, Ch 8, ‘Having Adrian’. 46 As noted, for example, in the interviews, carried out by the author, with Professors the late Walter Holland, 22 August 2016, Adrian Sinfield, 9 January 2016, and the late David Donnison, 4 December 2015. 47 Oakley, Father and Daughter, p 181 citing Paul Thompson’s interview with Peter Townsend. 48 Titmuss, ‘The University and Welfare Objectives’, pp 31–​2. 49 Blackstone et al, Students in Conflict, p 19, Table 2.4. 50 TITMUSS/​8/​13, press cutting from the Evening Standard, 14 May 1968 and letter, 23 May 1968, Townsend to Abel-​Smith, RMT, Crossman, Shore, and Williams. 51 Oakley, Father and Daughter, p 191. 52 Ibid, p 168. 53 H. Rose, ‘An Accidental Academic’, in M.  David and D.  Woodward (eds), Negotiating the Glass Ceiling: Careers of Senior Women in the Academic World, London, The Falmer Press, 1998, p 107. 54 Author’s interview with Professor David Piachaud, 12 January 2016. 55 Author’s interviews with Professors Pat Thane, 9 March 2016, and Howard Glennerster, 7 October 2015.

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29 ‘A new prophet had appeared in our midst’: final illness, death, and memorial service Introduction In 1969 Titmuss entered into discussions about his retirement date. He, like others in his age bracket, was originally due to retire at 65 (that is, in 1972), but this was extended by the LSE to 67. In May 1969, when all this was being formalised, he told Walter Adams that, in previous discussions, he had thought it ‘most unlikely that I shall want to stay on a full-​time basis to the age of 67. However, in looking at the regulations it would seem to be best at the present time to accept reappointment for the full term of five years’. It is clear that Titmuss had wanted to at least begin to wind down full-​time employment, while the School wanted him to stay on in some capacity. Adams had consulted Abel-​ Smith about this, with the latter responding that he had ‘no doubt at all that we would very much want Professor Titmuss to continue until the age of 67 if he would be willing to do so’.1 It was not to be. Titmuss died of lung cancer in spring 1973. A  sickly child, his health remained problematic throughout his life, outdoor activities such as hiking (especially in the 1930s, and 1940s) notwithstanding. Recurring tuberculosis in the late 1950s and early 1960s was problematic, as was a bout of dysentery contracted in Mauritius in 1960. As has been suggested, Titmuss’s demanding work schedule may have adversely affected his physical wellbeing. What was unquestionably a contributory factor in his relatively early death was that he, like Kay, had been a tobacco smoker throughout his adult life (one of Oakley’s memories of childhood is the smell of cigarettes pervading the family

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home). As Gowing records, the last years of Titmuss’s life were made all the more stressful by the deaths of his sister and his mother, and Kay’s health problems.2 Further complicating matters, Titmuss’s final, painful, illness was more than once misdiagnosed. But although his activities were severely disrupted in his last few months, he continued, when possible, to pursue his research, his work for bodies such as the Finer Committee and the SBC, and his teaching. This chapter first describes Titmuss’s illness, and his response to it. We then discuss the reaction to his death and especially the memorial service held at St Martin’s-​in-​the-​Field.

Cancer In July 1972, Adams congratulated Titmuss on his election to a British Academy Fellowship, telling him that ‘We are all delighted at this yet further recognition of your distinguished services to scholarship and to the welfare and happiness of mankind’. Then, with just a hint of the controversies in which Titmuss had been embroiled, Adams concluded that there was ‘still surviving some discriminating good sense in this naughty world, at least in the Academy (and LSE). Hooray’.3 Unfortunately, bad news soon outweighed the good, by some margin. As Jerry Morris was ruefully to recall, ‘I suppose I spent more effort in trying to stop him smoking than I did with any of my friends and completely failed’. Morris himself had quit when Richard Doll and Austin Bradford Hill published their findings on cigarette smoking and lung cancer in the early 1950s, research of which Titmuss could not have been unaware.4 Indeed, it is almost certain that Titmuss and Doll were, at the very least, acquainted from the late 1930s onwards, given the medical and political circles in which they moved.5 Oakley, too, notes that, notwithstanding the closeness of the Titmuss and Morris families, ‘Jerry failed to convince his friends of the health benefits of exercise and giving up cigarettes’.6 Titmuss’s problems started in early 1972 when he began to experience acute pain in his arm and shoulder. At this stage, Gowing comments, the ‘X-​rays of his TB-​scarred lungs revealed nothing’, while physiotherapy only made the pain worse.7 The point is, though, that initial diagnosis had suggested a muscular-​ skeletal problem.8 In October Titmuss’s colleague, Garth Plowman, wrote to Adams. Plowman’s news was ‘not good’.Titmuss’s cancer was ‘inoperable’, and his doctors were about to decide whether to use radium treatment. Plowman would inform the director when a more definite prognosis

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was available, but in the meantime ‘I think one can assume that it may be some time before he can return to take up his duties at the School’.9 This prompted Adams to write to Titmuss, and the latter, responding, thanked him for his letter which had ‘touched me very deeply’.Titmuss confirmed that radium treatment was imminent, would last for five or six weeks on an outpatient basis, and should help ease the pain. Adams and his wife were then invited to spend an evening at Titmuss’s home.10 It is unclear if this happened immediately, but in December Adams wrote to Titmuss in the wake of a telephone call from the latter. Treatment at this point appeared to be going well, and Adams confirmed that he and his wife would come to Titmuss’s home for dinner later that month.11 If nothing else, this small incident shows the close relationship Titmuss and Adams had built up. As Plowman’s letter suggests, though, all was not well.Also in October 1972,Titmuss told a colleague at the Ford Foundation that when they had last talked he had complained of ‘so-​called “frozen shoulder” ’ –​an expression denoting chronic pain, but with no connotations of cancer. However, his condition had now been diagnosed as bone cancer, and he was receiving daily radio-​therapy treatment.12 News of Titmuss’s illness spread quickly.The Reverend Graham Dowell of London University’s Anglican Chaplaincy told him that he should be aware by now ‘that you have many more friends than you ever dreamed of in and around the LSE who have been thinking of you with affection and hope since you went into hospital’. It was good to hear that Titmuss had been ‘allowed home to your family and your garden’, and that treatment had begun. It was sad he would not be able to attend a meeting with Shirley Williams, ‘and I know that she will be sad too’, but ‘we shall continue to think about you and, if you will allow it, remember you in our prayers’.13 This was one of a number of appointments Titmuss had to cancel because of illness, one of the more unusual being his invitation to speak at the Royal College of Defence Studies on the ‘welfare state’.14 A sense of what Titmuss had to endure in his last few months is captured in a letter of November 1972 to Alvin Schorr. It was a relief, Titmuss optimistically told him, ‘after so many months to know one’s enemy and to know also that the enemy can be beaten’. This helped with pain management, as well as highlighting the ‘marvellous treatment under the NHS’. He had spent 12  days in hospital, undergoing an ‘immense number of tests of all kinds’, and three hours in the operating theatre.When his post-​hospital treatment was taken into account, ‘I must have cost the NHS quite a fantastic sum!’ Each morning he

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and Kay took a cab to Westminster Hospital, returning by 11 o’clock. After more pain-​killers, he spent the afternoon in bed before, from around 4.30pm, seeing colleagues and graduate students.15 Around the same time, Titmuss told Wilbur Cohen that his ‘bone cancer … is painful and frustrating’. He had, though, now completed a five-​week course of treatment and the ‘consultant radiologist is optimistic about the next month or so’.16 In fact, the next few months remained difficult. In January 1973 Titmuss was invited, by Political Quarterly, to review the IEA publication The Long Debate on Poverty. He told the journal’s editor that, while he would have liked to have done so, ‘I find it painful and frustrating to write with this ridiculous bone cancer in my ribs’. He had been ‘undergoing radium treatment and am still feeling rather like an over-​cooked chicken’.17 It would have been interesting to have had such a review given that, for example, the author of the chapter on welfare praised the growth of occupational pension schemes.18 At least in his correspondence, Titmuss remained mostly hopeful until the end. He told Phyllis Wilmott just over a week before his death that he had, once again, to be operated upon, ‘but this time I hope they will be successful in getting rid of the pain’. As in many of these letters, Titmuss did not talk only of himself. In that to Schorr, he had discussed the latter’s employment prospects, while in Wilmott’s case he complimented her on the new edition of the Consumer’s Guide to the British Social Services, while commiserating about the effort she would have to make, in any future edition, in summarising the recent Social Security Act.19 A couple of days later, however, writing to the head of graduate students at the LSE, Anne Bohm, Titmuss was more downbeat. His last hospital visit ‘didn’t do the trick’. He would have to return to hospital within the next few days ‘for a major operation in which the surgeons are going to cut off the offending nerve fibres’.20 The operation was not successful.Titmuss’s lungs could not recover from the surgery, and he died in the Central Middlesex Hospital on 6 April 1973, aged 65. His attendance at the Central Middlesex had been arranged by his friend, Keith Ball, ironically a founder of Action for Smoking and Health.21 Kay and Ann were present.22 The latter has movingly described the latter, distressing, stages of Titmuss’s illness.23 At the time of his death Titmuss’s LSE salary, which had started at £1,800, stood at around £7,500, and the memo outlining his salary history also noted an ex gratia payment to Kay of just under £2,000.24 The net value of Titmuss’s estate was £37,833.43.25 In late 2010s values, this would be the equivalent of over a quarter of a million pounds.

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Soldiering on Titmuss’s final illness did not stop him teaching, thinking, or promoting his welfare philosophy. During his hospitalisation in autumn 1972, the principal tutor at the Westminster Hospital Nursing School thanked him for the signed copy of The Gift Relationship he had donated to the nurses’ library. This type of ‘wider reading’ was ‘so essential for today’s nurses’, but lack of funding meant such works were difficult to obtain. It would be ‘much read and appreciated’.26 A memorandum to Adams from the LSE’s financial secretary, John Pike, in February 1973 noted that ‘since Professor Titmuss started coming into the School again to teach, because he is under sedation he is coming and returning by private hire car’. Pike had ‘also heard that he is paying the fares of student tutees to be taught by him in his home’. Exercising the discretion his post undoubtedly required, Pike told Adams that ‘I know nothing of Professor Titmuss’s personal financial circumstances but thought you should be aware of the situation’.27 The following month, Titmuss was contacted by Ivor Dunkerton, producer of ‘Man Alive’, a BBC documentary series concerned with contemporary issues. Dunkerton told him that the response to ‘your/​our programme has really been rather incredible, if not slightly bewildering –​even overwhelming’. His original aim had been simply to avoid boring viewers, but to ‘receive letters in such numbers really is marvellous’. Almost all had been positive, ‘some ecstatic’: “The Best Documentary of the Century”, “1st Class”, “Magnificent”, “Worth the fee alone” (old age pensioner), “Best Programme of the Decade”, etc etc’. Dunkerton felt ‘ashamed’ to have his name at the end of the programme, ‘when it should have been yours’. He stressed how much he appreciated Titmuss’s ‘kindness, warmth, and patience –​especially since you have been suffering so much pain’. He had met many people in his professional life, ‘but I can honestly say I have not had so much pleasure and reward from meeting anyone as much as from you’.28 The episode in question was entitled ‘From the Cradle to the Grave’, a phrase associated with the Beveridge Report, published 30  years previously. The programme had been specially extended to nearly two and a half hours, and was shown on 21 February. It examined the circumstances of two families, the comfortably off middle class Copeley-​Williams, and the struggling working class Wadsworths, in four areas: income, housing, education, and health.29 In The Guardian, Nancy Banks-​Smith, apparently shocked by what she had seen, noted the marked difference in the two families’ experiences, and that as more and more information was given, ‘assorted experts talked, and

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then shouted, about the completed picture, the shocking contrast’.30 Unfortunately, no more detailed account appears to have survived. But the broader context was the Conservative government’s welfare policy. Keith Joseph, as Secretary of State for the Social Services, had introduced a new, means-​tested, benefit, Family Income Supplement. This sought to help low-​paid, working, families, but backfired, not least through creating a disincentive for low-​paid workers to earn more. Joseph had inadvertently created the ‘poverty trap’, the subject of sustained criticism by those such as Townsend, Field, and Piachaud.31 Given that the Wadsworths were described as ‘struggling’, it seems likely that the ‘poverty trap’ played an important part in the programme. Titmuss used his time in the NHS’s hands to record his impressions for his students’ benefit. Posthumously published as the postscript to Social Policy:  An Introduction, this had been the basis of Titmuss’s introductory talk to his last series of lectures before his death. He described, for instance, his conversation with a woman fellow patient who, like him, had cancer. She explained her reticence about telling anyone about her condition, cancer being ‘not very respectable’ –​a common response to this illness at that time. Would Titmuss tell his students about his own condition? As Titmuss put it, by this time she knew that he came from a ‘strange, peculiar place called the London School of Economics where she thought a lot of strange, peculiar students had a lovely time at the taxpayers’ expense’. But he would, of course, tell his students, and in so doing was keeping a ‘promise I gave her before Christmas’. Titmuss then outlined the course of his illness, his treatment, and his experience of Westminster Hospital. The latter included watching, with another fellow patient, a broadcast from Labour Party conference, held in Blackpool in October 1972, with Titmuss paying particular attention to the debate on the EEC. Never one to miss making a point, he remarked, too, that he had been allowed out of hospital to have dinner with friends and colleagues. Hospitals could thus be flexible, an ‘area where the middle classes can often get the best out of the social services’. Titmuss conceded he was middle class (it would have been hard not to) and ‘articulate where many of the patients are not’. He likewise acknowledged that he had been very lucky in the ward in which he was accommodated, noting that ‘you know, as well as I know, that not all wards are like the ward I was in’.32 When not receiving treatment, or watching television,Titmuss occupied himself with various reading materials, including John Rawls’s recently published A Theory of Justice. He commended this as ‘one of the most important books published in social philosophy in the last twenty-​five years’, while conceding that he had not got very far with

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it. But the bottle of whisky he also took with him probably eased the demands of this challenging text.33 Unfortunately,Titmuss did not elaborate on what he found so compelling in Rawls, but it may have been the latter’s desire to challenge what he saw as the still dominant mode of philosophical thinking, utilitarianism, by envisaging a new version of the social contract, and a conception of justice which constituted ‘the most appropriate moral basis for a democratic society’.34 While we should not over-​read Titmuss’s brief comment, it may be significant, nonetheless, that he was tentatively engaging with a thinker firmly in the liberal, rather than the socialist or social democratic, camp.35 In perhaps the most revealing passage, Titmuss recalled that he had often written of ‘social growth’ which, as we know, he saw as very different from economic growth. His hospital experience had provided ‘some of the unquantifiable indicators’ of this phenomenon. These could not be measured, quantified, or calculated, ‘but relate to the texture of relationships between human beings’. Consequently, and thus contrary to the claims of ‘my friends the economists’, they could therefore not be found in ‘all the publications of the Central Statistical Office’. His fellow television viewer, ‘Bill’, was severely disabled, but nowhere in the sort of material Titmuss so clearly deprecated could be found an explanation of NHS expenditure on his companion’s condition. Similarly absent was any acknowledgement of the other social services, such as social housing, which ‘Bill’ received. But the latter’s experience was an example of ‘what a compassionate society can achieve when a philosophy of social justice and public accountability is translated into a hundred and one acts of imagination and tolerance’. Moreover,‘Bill’ was, like Titmuss, a keen gardener.Titmuss recounted that during their time together ‘a book was published by a friend of mine’, Lady Pat Hamilton. Hamilton had founded the Disabled Living Foundation, and her book was Gardening for the Disabled. Within two days of its publication, ‘the mobile voluntarily-​ staffed library at Westminster Hospital, remembering Bill’s interest in gardening, sent up to him the book to read’. In a neat historical twist, Hamilton had been a WVS regional organiser during the war. We can see here further instances of voluntarism in action –​Hamilton’s organisation, and the hospital library, with Titmuss approving of both. This must, once again, raise questions about his supposedly downbeat approach to the voluntary sector. Another cancer sufferer, meanwhile, was a young man from Trinidad whose radiotherapy appointment time was the same as Titmuss’s. Who was seen first was determined by ‘quite simply the vagaries of London traffic –​not race, religion, colour or class’.36

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Remembering Richard Titmuss In the wake of Titmuss’s death, tributes came from a wide range of individuals and institutions. What is notable here is how many articulated aspects of what was by now a standard view of Titmuss, at least as he and his circle would have it –​risen from nowhere, unassuming but influential, empathetic, a dedicated public servant and teacher, an original thinker, and supported in his endeavours by Kay. In The Times, under the misleading subheading ‘An Outstanding Social Administrator’, Titmuss’s ‘immense influence on social thought in Britain and overseas’ was noted. After the erroneous claim that ill health had kept him out of the armed forces during the Second World War, appropriate weight was given to various aspects of his career. His writing on social policy matters was ‘enthralling’ –​in contrast to that of the Webbs, much of whose prose was ‘flat and dull’ –​not least through his concerns for welfare recipients, as well as policy makers and administrators.Titmuss’s participation in an ‘unending chain of government committees’ was acknowledged, as was his relationship with the Labour Party.And, as we saw in Chapter 24, this memorial also noted Titmuss’s role in shaping American policy on the collection of blood.37 Michael Young, meanwhile, described Titmuss as ‘Britain’s outstanding inspirer of post-​war social policy’, someone in ‘direct line of intellectual dissent’ from those other LSE stalwarts, the Webbs and Beveridge. The ‘insecurity’ he had experienced prior to joining the Civil Service had, in fact, been to his benefit, as it ‘gave him a feeling for the problems of ordinary people’.Titmuss had, simultaneously, been ‘a creator of the Welfare State’, as well as a ‘biting critic of its inadequacies’. Possibly his ‘greatest achievement’, though, ‘was that he took his achievements lightly. Loaded with fame, he remained the same bright-​ eyed, thin, inquisitive, nervous, compassionate, incisive, boyish man that he had been in the 1930s’. Revealingly, this piece was entitled ‘The Professor Who Had no “O” Levels’.38 Another old friend, Peter Shore, described Titmuss as the ‘most original and the most sensitive of post-​ war socialist thinkers’. Like Tawney, he had ‘understood that socialism was not only about ending the cash and power nexus’. It also sought to improve the ‘quality of human and personal life’.Titmuss’s own lifestyle, ‘no less than his political philosophy’, went against the values of ‘the acquisitive and affluent society’. He was ‘a great and good man’.39 In The Spectator, Patrick Cosgrave, later a sympathetic biographer of Enoch Powell, described Titmuss as someone with a ‘powerful and systematic mind’, the ‘unchallenged leader of socialist thinking on welfare’ in Britain, and a man of ‘great charm and breadth of sympathy’.40

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Titmuss’s early supporter and sometime hiking partner, Keith Hancock, recalled a ‘gentle, modest man with deep reserves of intellectual and moral power’ who possessed the ‘simplicity of genius’.41 The SBC chair, Lord Collison, saw Titmuss as a ‘true universalist’ whose work ‘reflected a great human spirit’. He praised Titmuss’s breadth of knowledge, and how he had ‘fully understood the feelings of the claimants and also those of the operational staff ’, in both cases driven by a ‘compassionate concern for people’. ‘The Commission’, Collison concluded, ‘greatly loved and respected him and his wife Kay, for like all great men he enjoyed her loving support in all he did’.42 From longstanding, first-​ hand, experience, Abel-​Smith suggested that the recognition of Social Administration by British academics owed ‘more than anything else to the standing of Titmuss’s work’. In his own conduct, moreover,Titmuss had shown ‘how to live and how to perform the office of university teacher’.43 And, in a touching gesture, Townsend dedicated a public lecture to his late, if latterly somewhat estranged, mentor. Entitled ‘Inequality and the Health Service’, this contained numerous passages of which Titmuss would have approved. For instance, health services were ‘social institutions’, subject to change. Townsend noted, too, the dependence of countries such as Britain and the United States on doctors from poorer countries, citing an essay in Commitment to Welfare in support of his argument.44 Many others expressed their sympathies. Picking up on Titmuss’s work in Africa, and his department’s embrace of students from abroad, M.I. Ikhimokpa wrote to Adams from Nigeria to express ‘his sincere condolence upon the loss of a Professor who had endeared himself to overseas students’. With his death ‘the University has lost one of her original thinkers in the field of Social Sciences’.45 Marie Meinhardt, the German refugee who had helped Titmuss with health research in the 1940s, told Kay how much Titmuss had meant to her, not least because of the assistance he gave to her, and her husband, when they applied for British citizenship after the war.46 The LSE itself recorded Titmuss’s death, with the Standing Committee ‘noting with regret the death of one of its members’.Adams had ‘paid tribute to his distinction and to his courage during his fatal illness’. The chairman would send his condolences to Kay on the committee’s behalf, and it was further noted that a memorial service was to take place.47

Memorial service Organised by Abel-​Smith, the memorial service was held at St Martin’s-​ in-​the-​Field, a central London church near the LSE, on Wednesday 6

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June 1973. Some of his friends were uneasy about an Anglican service, with Barbara Wootton declining to attend for this reason.48 It is worth pausing to note the impact of Titmuss’s death on Abel-​Smith.Accounts vary as to where he actually was when Titmuss died. Sheard has him at Westminster Hospital, while Oakley has him in his LSE office with Hilary Rose. Either way, Sheard is surely correct in describing Abel-​ Smith as ‘devastated’. He and Titmuss had, from almost the beginning of their relationship, been in virtually daily contact. Abel-​Smith had thus lost ‘his mentor, friend and father-​figure’, his ‘academic godfather’.49 We have already suggested a sort of paternal relationship between Titmuss and Townsend, and this aspect of the former’s character will be briefly discussed in the next chapter. In advance of the service Kay wrote to Adams. She had ‘read and re-​read’ his letter, which was one of the ‘most beautiful among the many I have received and means so much to me’. The ‘love and admiration’ which he had expressed for Titmuss she knew were reciprocal. Titmuss had frequently spoken of Adams ‘as a person and as Director of his beloved LSE’. As a ‘further favour’ she asked him to speak at St Martin’s, for his ‘knowledge of Richard and his work is a unique one and quite apart from that of the other speakers’.50 As it turned out, Adams did not speak, but what is revealing here is, once again, the respect he and Titmuss had for each other. In addition to family members, those in attendance, and reflecting Titmuss’s wide range of activities, interests, and contacts, included the High Commissioner for Mauritius, Lord Collison, and senior members of the LSE, such as Adams and the Chair of Governors, Lord Robbins. Among the notable political attendees were Sir Keith Joseph, and Shirley Williams. Senior officials from various government ministries were also present. From the voluntary sector, meanwhile, there were representatives of the NAMH, the CPAG (in the shape of Frank Field), and the National Council for the Unmarried Mother and Her Child. Among former colleagues and friends present were T.H. Marshall, Jerry Morris, and the LSE historian Donald Cameron Watt.51 The event was led by the church’s vicar, the Reverend Austen Williams, and the address given by the prominent anti-​racism campaigner (and, like Titmuss, native of Bedfordshire), the Right Reverend Trevor Huddleston, Suffragan Bishop of Stepney. Abel-​Smith and Sally O’Brien, a student in the Department of Social Science and Administration, delivered readings, while tributes came from Crossman and Cohen, now at the University of Michigan.52 The content of the St Martin’s event was revealing. One of the two hymns was Blake’s ‘Jerusalem’, set to music by the quintessentially English composer, C. Hubert H. Parry. O’Brien’s reading was from

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Psalm 15, which, posing the question who shall enter Heaven, includes the lines ‘he, that leadeth an uncorrupt life; and doeth the thing which is right, and speaketh the truth from his heart’. Abel-​Smith’s contribution, meanwhile, was the famous passage from Paul’s first letter to the Corinthians which concludes ‘And now abideth faith, hope, charity, these three; but the greatest of these is charity’.53 Without stretching the point, we can again see here a reflection of the view of himself Titmuss wanted to project to the world: English patriot, principled, a speaker of truth to power, and concerned with high moral issues. It is notable, too, that Huddleston claimed that Titmuss exhibited ‘true Christian values’.54 As to the tributes, we encountered Cohen’s assessment of Titmuss as a writer and thinker in Chapter 24. But he also spoke of what he described as Titmuss’s ‘human qualities’. Cohen recalled the occasion, in 1967, when he and Titmuss had found themselves at Moscow Airport. They had just come from an International Social Security Association meeting in Leningrad (St Petersburg), of which Titmuss gave an account in a piece later included in Commitment to Welfare. Titmuss discovered that he could not convert his roubles, of which he had around £40 worth (more than £400 at late 2010s values), into sterling. As Cohen put it, their ‘major social policy problem was how to spend 40 pounds in two hours in a country with limited consumer goods but lots of vodka’. An attempt to be intelligent consumers failed, and the outcome was vodka and chocolates, presumably in large quantities. Cohen ruefully observed that no more ‘unsuccessful effort in the allocation of scarce resources was ever tried’. But what was important was that ‘Richard took his plight in good humor’. Titmuss was a ‘gentleman and a scholar’, someone ‘who believed that ideas are weapons in the fight against poverty, hunger, ignorance and disease’. He had been ‘an understanding man; a man respected; admired and loved for the beauty of his spirit’. Cohen closed: ‘We thank thee Richard for what you have given us’.55 He was obviously taken by their Russian escapades, having written to Titmuss in 1971 that, during his impending visit to England, ‘I don’t suppose we will be able to cavort around as you and I did in Moscow Airport’.56 Cohen later distributed copies of his address to American colleagues.57 Abel-​Smith, meanwhile, told him that he had been ‘marvellous at that very memorable June 6th’.58 Kay wrote, too, thanking Cohen for ‘your tribute to Richard at that wonderful service’. It was ‘so right that you should talk of his influence in the US and you did it beautifully’.59 Crossman’s address is worth dwelling on because of the insights of its politically shrewd, and intellectually curious, author, even allowing

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that it was given at a commemorative service, and not in an academic critique.60 He began by arguing the need for ‘prophets’ in national life who could, by their writings, and ‘even more by their conversation’, remind people of what they might aspire to achieve. Titmuss was a prophet of this kind, both for Crossman himself, and for ‘many other politicians of my own and of a younger generation’, and here he specifically referred to Keith Joseph. Crossman’s first contact with Titmuss had been when Tawney had reviewed Problems of Social Policy for The New Statesman, where Crossman was then working. He made enquiries about Titmuss and found, to his initial annoyance, that ‘some of his young disciples referred to him, behind his back, as God’. But when Crossman met Titmuss, he recognised that he was ‘not like other men. His eyes and his conversation shone with a moral force which made one ashamed of one’s usual political back chat and to listen to him when his moral indignation was aroused was a searing experience’. He had come to love Titmuss, and hold him in awe. Titmuss had inherited Tawney’s mantle, and his ‘central doctrines’ as expressed in works such as Equality. But Titmuss’s thinking was an advance on Tawney’s because of its emphasis on altruism, which he believed to be a ‘universal instinct’.Titmuss’s ‘greatest book’, The Gift Relationship, ‘proved triumphantly’ that altruism was not only ‘morally better, it is more efficient, it is cheaper and it never fails’.Titmuss did not, though, believe in ‘flat-​rate equality’. Rather, he sought to level up rather than down through, for example, the provision for every citizen of a state pension equal to that provided by private superannuation. Similar concerns had prompted him to accept the deputy-​chairmanship of the SBC, and one of Crossman’s greatest pleasures as a minister was Titmuss working at the commission ‘in such harmony with his friend, Lord Collison’. But Titmuss’s greatest affection was for the NHS. His investigations into American medical practice, by contrast, had provoked ‘his outraged contempt for the vain effort to provide a health service based on the profit motive’. On a more personal level, and in an unnecessary jibe, Crossman found another difference between Titmuss and Tawney in their marriages. The latter’s was ‘an encumbrance’ whereas, as also noted in Chapter 2,Titmuss’s ‘home life was an inspiration not only to him but to those who partook of Kay’s hospitality’. Titmuss was already seriously ill by the time of Crossman’s last meeting with him. But he had no reluctance to speak about his condition, describing in ‘very great detail’ his new treatment. He had ‘worked out delightedly the vast number of pounds per minute it cost … I have never seen a man happier than he was at that moment’.A ‘great man has

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been taken away from us but as is the way with prophets his teaching will live and bear fruit long after most of us assembled here today are dead and forgotten’. A week later, Kay thanked Crossman for his contribution, remarking, again as we saw in Chapter 2, that it was ‘hard to face the future without Richard and sad that he had to leave us when there was still so much he wanted to do’. But Crossman was right that ‘other people caring and missing him too does comfort me’.61 Kay also told Adams that she was grateful to him, and his wife, for ‘your kindness and support last Wednesday’. It had been a ‘memorable occasion’, and ‘wonderful to have so many friends gathered in St Martins’. She and Ann had been ‘honoured and comforted by the consciousness of so much warmth and sympathy around us. It means a great deal when one has lost so much’.62 As to Kay’s state of mind, Margaret Gowing told Adams in July that she had had a ‘long talk on the phone last week with Kay Titmuss who sounded extremely depressed but she was going away with Janet Kidd for a few days’.63 The Titmuss Memorial Fund was set up in early summer 1973. A letter from Abel-​Smith and Plowman to The New Statesman described its aims, these being to help LSE students,‘particularly mature students and students from developing countries with inadequate support, to take courses or undertake small research projects’. Contributions were invited, to be sent to the fund’s secretary, Angela Vivian.64 Individual letters were also sent out, for example to Titmuss’s longstanding colleague Judith Hart, at this point president of the LSE Society as well as a member of Labour’s Shadow Cabinet. She contributed £5.65 Crossman, meanwhile, received a note from Vivian about his contribution to the fund, adding that she ‘greatly enjoyed your tribute to Richard last Wednesday –​in fact I found the whole occasion memorable and I know this must have been so for everyone there’.66 The fund later became the Titmuss-​Meinhardt Fund as a result of a bequest by Marie Meinhardt in Titmuss’s memory, and still operates.67 The question of Titmuss’s papers was addressed within weeks of his death. Adams wrote to the School librarian, Derek Clarke, ‘just to put on record what I told you’. He had had an ‘entirely private conversation’ with Abel-​Smith in which the director had expressed the view that ‘whatever happened to them it was most important that they should be kept together as a single collection and not dispersed among the numerous bodies with which Professor Titmuss had connections’. Should Kay agree, the LSE would happily receive the collection, and was well used to managing such materials. So at ‘the appropriate time, Professor Abel-​Smith will discuss this matter with Mrs Titmuss and

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let me know her wishes. We should make no further move ourselves until we have heard from him’.68 This volume has drawn extensively on this donation.

Conclusion From all the available evidence, Titmuss faced his final illness courageously and stoically. In a manner exemplifying his character, he not only endured his medical treatment, he sought, too, to draw lessons from his experience. Where at all possible, he continued to work at his usual, relentless, pace, and kept on interrogating the delivery, and aims, of the social services. The volume and diversity of responses to his death attest to his impact, and the reach of his approach to social welfare. In the next, concluding, part/​chapter, an attempt is made to assess Titmuss’s life as a whole, and especially what constituted his ‘philosophy of welfare’. Notes 1 LSE/​Staff File/​Titmuss, letters, 22 May 1969, RMT to Adams, 19 May 1969, Adams to RMT, and 6 May 1969, Abel-​Smith to Adams. 2 M. Gowing, ‘Richard Morris Titmuss, 1907–​1973’, Proceedings of the British Academy, LXI, 1975, p 29. 3 LSE/​Staff File/​Titmuss, letter, 24 July 1972, Adams to RMT. 4 ‘Professor Jerry Morris in Interview with Max Blythe, 9 May 1986’, typescript of the Royal College of Physicians and Oxford Brookes University Medical Sciences Video Archive MSVA 008, p 9. 5 C. Keating, Smoking Kills: The Revolutionary Life of Richard Doll, Oxford, Signal Books, 2009, for example at pp 102, 291; G.  Watts, ‘Why a 1940s Medical Committee Should Not Be Forgotten’, British Medical Journal, II, 2001, p 360. 6 A. Oakley,‘Appreciation: Jerry (Jeremiah Noah) Morris, 1910–​2009’, International Journal of Epidemiology, 39, 1, 2010, pp 274–​76, 276. 7 Gowing, ‘Richard Morris Titmuss’, p 29. 8 Oakley, Father and Daughter, p 206. 9 LSE/​Staff File/​Titmuss, letter, 9 October 1972, Plowman to Adams. 10 LSE/​Staff File/​Titmuss, letter, 14 October 1972, RMT to Adams. 11 TITMUSS/​7/​80, letter, 3 December 1972, Adams to RMT. 12 TITMUSS/​7/​80, letter, 19 October 1972, RMT to Arthur Cyr. 13 TITMUSS/​7/​80, letter, 24 October 1972, Dowell to RMT. 14 TITMUSS/​7/​81, letter, 22 December 1972, RMT to Rear Admiral A.S. Morton. 15 TITMUSS/​AO, letter, 11 November 1972, RMT to Schorr. 16 TITMUSS/​AO, letter, 23 November 1972, RMT to Cohen. 17 TITMUSS/​AO, letter, 4 January 1973, RMT to Richard Greaves. 18 C.G. Hanson,‘Welfare before the Welfare State’, in R.M. Hartwell (ed), The Long Debate on Poverty, London, IEA, 1972, pp 137–​8. 19 TITMUSS/​AO, letter, 28 March 1973, RMT to Willmott. 20 TITMUSS/​7/​81, letter, 30 March 1973, RMT to Bohm.

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‘A new prophet had appeared in our midst’ 21 Gowing, ‘Richard Morris Titmuss’, p 29; and discussion with Professor Ann Oakley, December 2019. 22 Oakley, Father and Daughter, p 149. 23 A. Oakley, Taking it Like a Woman, London, Jonathan Cape, 1984, pp 104–​12. 24 LSE/​Staff File/​Titmuss, memo, undated but 1973, ‘Professor Richard Morris Titmuss: Salary’. 25 LSE/​Staff File/​Titmuss, Probate Statement, 12 September 1973. 26 TITMUSS/​7/​80, letter, 23 October 1972, Miss E. Gibbon to RMT. 27 LSE/​Staff File/​Titmuss, memo 8 February 1973, J.P. (John Pike) to Adams. 28 TITMUSS/​AO, letter, 2 March 1973, Dunkerton to RMT. 29 Radio Times, 17–​23 February 1973, p 37. 30 N. Banks-​Smith,‘Man Alive on Television’, The Guardian, 22 February 1973, p 12. 31 N. Timmins, The Five Giants: A Biography of the Welfare State, London, William Collins, 3rd edn 2017, pp 282–​3. 32 Titmuss, Social Policy: An Introduction, pp 145, 147–​8. 33 Ibid, pp 149–​50. 34 J. Rawls, A Theory of Justice, Oxford, Oxford University Press, 1972, p viii. 35 M. Freeden, Liberal Languages:  Ideological Imaginations and Twentieth-​Century Progressive Thought, Princeton, NJ, Princeton University Press, 2005, p 30ff. 36 Titmuss, Social Policy, pp 147, 150–​1. 37 ‘Professor R. Titmuss: An Outstanding Social Administrator’, The Times, 7 April 1973, p 16. 38 M.Young,‘The Professor Who Had no “O” Levels’, The Observer, 8 April 1973, p 9. 39 P. Shore, ‘Richard Titmuss: A Great Socialist’, Tribune, 13 April 1973, p 4. 40 P. Cosgrave, ‘Richard Titmuss’, The Spectator, 14 April 1973, p 452. 41 Sir K. Hancock, letter, ‘Richard Titmuss’, The Times, 15 May 1973, p 18. 42 Lord Collison, letter, ‘Professor R.M. Titmuss’, The Times, 12 April 1973, p 20. 43 B.Abel-S​ mith,‘Richard Morris Titmuss’, Journal of Social Policy, 2, 3, 1973, pp i–​ii. 44 P.Townsend,‘Inequality and the Health Service’, The Lancet, I, 1974, pp 1179, 1180. 45 LSE/​Staff File/​Titmuss, letter, 12 May 1973, Ikhimokpa, Ministry of Home Affairs and Information, Nigeria, to Adams. 46 A. Oakley, ‘Legacies of Altruism: Richard Titmuss, Marie Meinhardt, and Health Policy Research in the 1940s’, Social Policy and Society, 18, 3, 2019, p 388. 47 LSE/​Staff File/​Titmuss, minute, 1 May 1973, Standing Committee, LSE. 48 Discussion with Professor Ann Oakley, December 2019. 49 Sheard, The Passionate Economist, pp 279–​80, 3; Oakley, Father and Daughter, p 159. 50 LSE/​Staff File/​Titmuss, letter, 1 May 1973, Kay to Adams. 51 For the full list, ‘Memorial Service: Professor R.M. Titmuss’, The Times, 7 June 1973, p 21. 52 TITMUSS/​ADD/​2/​3, order of service, Professor Richard Titmuss, 1907–​73:  A Thanksgiving. 53 COHEN, Bbox 235, folder 7,‘Professor Richard Morris Titmuss: A Thanksgiving’. 54 D. Reisman, Richard Titmuss: Welfare and Society, Basingstoke, Palgrave 2nd edn 2001, p 25. 55 COHEN, box 235, folder 7, W.J. Cohen, ‘A Thanksgiving for Richard Titmuss: June 6, 1973, London, England’; Titmuss, ‘The Relationship between Social Security Programmes and Social Service Benefits’, in Commitment to Welfare. 56 COHEN, box 235, folder 7, letter, 17 February 1971, Cohen to RMT. 57 COHEN, box 196, folder 5, letter, 20 June 1973, Cohen to Abel-​Smith. 58 COHEN, box 196, folder 5, letter, 31 July 1973, Abel-​Smith to Cohen.

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RICHARD TITMUSS 59 COHEN, box 235, folder 7, letter, 25 June 1973, Kay to Eloise and Wilbur Cohen. 60 The following comes from CROSSMAN, MSS.154/​3/​TM/​7–​11, typescript of Crossman’s address. 61 CROSSMAN, MSS.154/​3/​TM/​17, letter, 12 June 1973, Kay to Crossman. 62 LSE/​Staff File/​Titmuss, letter, 9 June 1973, Kay to Adams. 63 LSE/​Staff File/​Titmuss, letter, 27 July 1973, Gowing to Adams. Gowing almost certainly meant ‘Janet Kydd’, a former colleague of Titmuss’s, and an ally during his dispute with Eileen Younghusband. 64 Letter, B. Abel-​Smith and G. Plowman,‘Titmuss Memorial Fund’, New Statesman, 8 June 1973. 65 HART, Hart/​13/​45, undated letter but summer 1973, B.  Abel-​Smith and G. Plowman, ‘Titmuss Memorial Fund’. Hart wrote ‘£5’ on her copy. 66 CROSSMAN, MSS.154/​3/​TM/​19, undated note,Vivian to Crossman. 67 Oakley, ‘Legacies of Altruism’, pp 389–​90. 68 LSE/​Staff File/​Titmuss, memo, 24 April 1973, Adams to Clarke.

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Part 6

CONCLUSION

30 A commitment to welfare: the life and work of Richard Titmuss Introduction In 1964, Titmuss and Abel-​Smith appeared on the recently launched television channel, BBC2, in its series ‘Tuesday Term’. Aimed at sixth-​ form students, one strand, overseen by the LSE, concerned the social sciences. They spoke about Social Administration, defined as ‘the study of social needs and social services’. At university, it was taken by those wishing to work in the social services, or in government, who would perform better with an understanding of ‘how they fit into the wider picture’. Their field rested ‘heavily on history’, used comparative method, and studied official institutions and the charitable sector. But its ‘most searching questions’ were ‘philosophical’, and concerned the balance between individual and social responsibility. Social Administration’s ‘special contribution’ was the ‘collection and study of the relevant facts’, used to define various forms of need. The next step was to determine whether these needs had been met. In a democracy, universities had an important role in ‘ferreting out facts which may be uncomfortable for the government’, whose ministers may have made claims subsequently revealed as untrue.1 Three years later,Titmuss gave a speech entitled ‘Welfare State and Welfare Society’. But, he told his audience, that title had not been his choice. He was ‘no more enamoured today of the indefinable abstraction “The Welfare State” than I was some twenty years ago’ when ‘the term acquired an international as well as national popularity’. Such ‘Generalized slogans’ were intellectually stifling, led to moral complacency, and to a retreat into ‘our presumptive cosy British world of welfare’. It could be safely assumed, though, that the ‘reading habits of international bankers and

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economists’ did not include ‘studies on welfare and the condition of the poor’.What had arisen, nonetheless, was a depiction of ‘welfare’ as a ‘public burden’.2 These talks illustrate two of Titmuss’s central preoccupations. First, from his appointment at the LSE he sought to reshape Social Administration by way of rigorous empirical research, underpinned by more ‘philosophical’ concerns. The field had practical applications, including holding those in power to account, but it should also play a leading role in promoting a better society. Second, Titmuss was consistently critical of the expression ‘welfare state’, the phrase being commonly used to describe social services directly provided by the state. As such, they were all too easy to portray as constraining economic growth, with costs borne by the long-​suffering middle classes. Orthodox economics could not, or would not, deal with the dynamic realities of ‘needs’ in a changing society. Social policy should therefore be flexible, while retaining a moral basis.This chapter further expands on these ideas by, first, a brief recapitulation of Titmuss’s life and career. Second, we examine his ‘philosophy of welfare’. Third, we ask: where does he stand in the twenty-​first century? Finally, we discuss whether what was ultimately important about Titmuss was his particular way of addressing social questions.

Life and career The Titmuss story, especially as portrayed by Kay, was that he had risen, through his own efforts, from modest beginnings to a leading position in post-​war social science. Although his origins may not have been quite as humble as is often suggested, his was, nonetheless, a remarkable life. Even while working at the County Fire Office he was clearly ambitious and socially engaged. One of the post-​1945 great and good, Noel Annan, makes important points about Titmuss, and his historical context, in his sometimes tendentious book about Britain’s movers and shakers in the second half of the twentieth century, especially those from the LSE and Oxbridge, Our Age. But Annan is surely right that the ‘experience or memories of capitalism’s cataclysm, the Depression of 1931, ate into the consciousness of Our Age’.3 It was in the 1930s that Titmuss devoted himself to the Liberal Party, launched his writing career, and began making important personal connections. All this led to his employment to write Problems of Social Policy. John Vaizey recalled his excitement at its appearance in the immediate aftermath of his Cambridge economics degree, a degree notable for its lack of

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engagement with welfare matters. Having himself been evacuated, Vaizey found the passages on such matters ‘deeply resonant, affecting, and involving’.4 It certainly struck a chord, playing a critical part in Titmuss’s LSE appointment. From this platform, A.H. Halsey claims, Titmuss ‘held a famous position in the London pantheon of post-​war key holders to a better Britain and a more humane, more just, more civilised world’.5 For Annan, among the important denizens of Our Age, soon to be ridiculed as ‘The Establishment’, was that ‘saintly man’,Titmuss, whose influence on 1960s social policy could ‘hardly be exaggerated’. Ministers had realised that ‘outsiders rootling in Whitehall’s backyard could help them and as the dons began to be seconded to the ministries, the civil servants became less suspicious of them’.Titmuss probably never rootled in his life, but Annan’s comments are, nonetheless, insightful. How, he then asked, did one become a member of ‘Our Age’? The answer was in ‘the same way that most people have always got accepted –​by ability, by family connections, and knowing somebody’.6 Titmuss qualified on the first and third of these, being undoubtedly talented, and, by 1945, already respected by influential people. Titmuss’s post-​war career came on the back of an extraordinary, usually self-​imposed, workload. He was, from the outset, a committed teacher while determined to move his field on from its previously rather functional approach. Part of this involved collaboration with the Labour Party, with Crossman’s patronage particularly important. It was also in the 1950s that Titmuss began to articulate more fully his ‘philosophy of welfare’, including an emphasis on its moral foundations. Here Titmuss drew on what he perceived as a key aspect of the Home Front during the Second World War, social solidarity, and the related belief that, given the opportunity, people will act not only for themselves, but also for others. The National Health Service –​universal, comprehensive, funded out of general taxation, and free at the point of consumption –​encapsulated what welfare could achieve. In the 1960s and early 1970s, Titmuss was at the peak of his influence. He maintained his prodigious publication output, participated in LSE governance, engaged with other countries’ welfare systems, and continued to serve on various committees and enquiries. He was also seen as someone who could explicate the Labour Party’s ambitions. Shortly before the 1964 general election he was invited by Independent Television News to participate in a programme to be broadcast in the event of a Labour victory. The proposed discussion, which would also involve the physicist Patrick Blackett and Labour’s economic advisor

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Thomas Balogh (both would take up senior advisory posts with the new administration), would centre on ‘what new patterns of everyday life might be expected to emerge over the next five years’.7 When Titmuss received his CBE in 1966, among those to congratulate him was Labour’s Hilary Marquand. The award was ‘recognition … of all your valuable public work over the years’, and not simply his contributions to the National Insurance Advisory Committee (the official reason for the honour). Would Titmuss lunch with him at the Reform Club? Never one to turn down such invitations, Titmuss agreed.8 It has been speculated that, two years earlier, a peerage had been on offer. In any event, Oakley records that, just before his death, Titmuss told Harold Wilson that, should Labour return to power, he was prepared to go to the Lords.9 For those who see Titmuss as having joined ‘The Establishment’, his willingness to accept such honours is compelling evidence. Titmuss also affected people personally. Adrian Sinfield recalls attending, in the 1960s, a meeting in addressed by Titmuss shortly after his return from Mauritius. Sinfield was so impressed he invited Titmuss back to Oxford, where he was a student, to talk on Mauritius to the Royal Commonwealth Society. Pat Thane likewise heard Titmuss while at Oxford in the 1960s, and she, like Sinfield, was prompted to study Social Administration at the LSE.10 These are but two instances of Titmuss’s impact, with Sinfield going on to a distinguished career in Social Policy, while Thane became a leading historian of modern Britain. Although the general consensus is that Titmuss was a compelling speaker, and here it is worth recalling his frequent appearances on broadcast media, it should also be recorded that not everyone was bowled over by his lecturing style.11 Of course,Titmuss’s vision of, and expansion of, Social Administration was not universally welcomed, even at the LSE. Other School members questioned its academic merits, partly a hangover from when the department’s principal function was training social workers.12 And not everyone bought into the Titmuss message. From the political left, colleagues such as Townsend became increasingly uneasy with certain positions Titmuss embraced, especially from the mid-​1960s. From the opposite end of the political spectrum, he was attacked by proponents of the ‘free market’. But such critiques may have consolidated his position with leading Labour Party members. Following the 1970 general election defeat, Shirley Williams took over the social security brief. She told Titmuss that she was ‘very conscious’ that she was no expert on the subject. Could they meet, as she could ‘think of few people from whom I could hope to learn more than you’?13

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By the time of his death, Titmuss was, at least for most on the liberal left, the commanding figure in what was increasingly described as ‘Social Policy’. For his supporters, and indeed for many of his critics, his arguments demanded respect, if not necessarily total agreement. But what of Titmuss as a person? He had what seems to have been a happy marriage. He was an affectionate grandfather, although perhaps not an especially ‘hands on’ one.14 And his relationship with Ann was troubled at various points.Their disagreements notwithstanding, though, Oakley makes clear their mutually loving relationship, and her profound grief at her father’s death.15 With students and colleagues he appears to have been supportive and loyal. Loyalty, though, had to be reciprocated, as the case of Townsend shows. On both sides, the breakdown in their relationship was seen as a betrayal, and what had been close to a filial relationship ended on a sour note. Abel-​Smith, who of course did not ‘betray’ Titmuss, likewise seems to have viewed him as a sort of father figure. Freudian dynamics aside, all this points to the tight-​knit circle around Titmuss at the LSE where, in his field, he was treated as the ultimate authority. But for less than true believers, or those outside the inner circle, this made him authoritarian, elitist, and remote. Did some of these characteristics derive from an essential insecurity, the ‘son of a farmer’ thrown into academic life and ‘The Establishment’ circles of the ‘great and the good’? This is plausible. Nonetheless, Titmuss was, from the 1930s onwards, self-​confident enough to speak frequently in public, promote his ideas through various media, and engage with senior civil servants and politicians, in Britain and elsewhere. Having said that, he could be, on occasion, priggish and didactic, perhaps a defence mechanism in someone not always entirely sure of himself. Similar ambiguities surround his attitude to women. His dispute with LSE social work staff can be presented as Titmuss on the one hand, female colleague on the other. But not all such social work colleagues opposed him, and in other parts of his professional life he dealt with female co-​workers on an apparently equal basis. And without condoning the situation, the male-​dominated world of post-​war higher education, and British society generally, must be borne in mind. Ultimately, though, what is most striking about Titmuss was his powerful work ethic. It would be absurd to suggest he had no private life, but less absurd to ask how much time he was able to devote to it. His archived papers, it should be emphasised, shed little light on his outside activities, and, in the last resort, if Titmuss is to be remembered, it will be as a public figure. We therefore now turn to what that public figure sought to achieve, and what ideas underpinned his aspirations.

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A ‘philosophy of welfare’? Titmuss has routinely been described as a socialist, a term he similarly used of himself. In particular, he has been portrayed as the ‘heir’ to Tawney and his ethical socialism. Titmuss was undoubtedly much influenced by Tawney but, in the first instance, while a Liberal Party activist it was the ‘ethics’, rather than the ‘socialism’, which captured the younger man. Even after the 1940s, when he adopted a more ‘collectivist’ political position and began a close relationship with prominent Labour politicians,Titmuss’s ‘socialism’ presents a number of problems. For instance, while critical of capitalism, and with his own view of what might constitute a ‘good society’,Titmuss never articulated what, if anything, might replace the prevailing economic system. Nor did he seriously question existing political arrangements. Similarly, he rarely mentioned trades unionism, and when he did it was not usually in a very flattering way. If, after all, the self-​interest of bodies such as the BMA was unpalatable, why should that of organised labour be any different? This was not an especially popular position in the post-​war Labour Party. For Titmuss, collectivism should entail the kind of social solidarity which had driven British society in the 1940s. He was not a ‘class warrior’. He had strong views about individual rights, though, stretching back to the 1930s. In a speech in 1964, Titmuss stressed that in planning services for the elderly, the aim should be ‘the enlargement, or at least the preservation, of the individual’s sense of freedom and self-​respect’.16 The maintenance of individual rights also underwrote his concerns about automation’s impact on individual workers, and what he saw as the social conformity, and morally deadening effect, of ‘The Affluent Society’. Similarly, while the NHS provided a necessarily universalist framework, patients were not obliged to use it, or doctors to work in it. And while a fierce opponent of excessive inequality, as Crossman shrewdly noted at his memorial service, Titmuss was not an advocate of ‘flat-​rate equality’. Crossman had defended Titmuss when he argued for pension contributions (and consequently payments) which moved beyond the flat-​rate system, cherished on the grounds of its supposed egalitarianism by parts of the labour movement. Titmuss’s support for voluntarism, most notably by way of the altruism of blood donors, should also be seen in the light of his promotion of individual social action. If he was not a ‘class warrior’, it is equally difficult to place him squarely in the Fabian ‘statist’ tradition. David Kynaston notes Titmuss’s ‘deep attachment to individual freedom and individual dignity, even as he moved into a more collectivist intellectual orbit’. For both the

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Labour Party and collectivism more broadly, Kynaston concludes, it would ‘have been a happier story’ if, during the era of post-​war consensus, more faith had been placed in ‘liberal values’ and less in ‘the state and its appointed experts’.17 For those seeking ‘lessons’ from Titmuss’s approach, this might be a good starting point. The notion of ‘liberal values’ again reminds us of Titmuss’s early political commitment, while also suggesting something deeper. Michael Freeden argues that Titmuss was an ‘intellectual successor to new liberal thought’, that is the pre-​1914 reshaping of liberal ideology which sought to balance individualism and collectivism. Titmuss’s work also showed the persistence of organic views of society, another feature of Edwardian liberalism, which in turn links to philosophical idealism. Such views stressed human interconnectedness. If ‘civil society has become regulated by the state, it was not to destroy voluntarism and individualism but precisely the reverse:  in order to encourage and develop the private, or interpersonal, values of altruism and care’. Since, by definition, altruism could not be enforced, and in any event Titmuss rejected ‘an exaggeratedly communitarian view of human relationships’, then individuals could waive the ‘right to give’ although both they as individuals, and society as a whole, would consequently be poorer.18 In a further challenging insight, Freeden sees Titmuss as someone whose ‘contribution to British social democratic thinking has not been adequately recognised’, someone who engaged not only with an ‘organic’ version of social organisation but also with ‘the claims of individual liberty’. More than this, though, he identifies in Titmuss’s thought the ‘combination of altruism and social care with market choice’.19 Linking Titmuss with ‘market choice’ seems off the mark. But, as noted, his critique of contemporary capitalism was less concerned with it as an economic system, and more with its material and moral side effects, while we have likewise stressed Titmuss’s concern for individual freedom of action. So Freeden has a point. Stefan Collini, meanwhile, places an essay on Titmuss in a chapter entitled ‘Moralists’. Here he is located alongside Tawney, the ground-​ breaking cultural critic Richard Hoggart, and the historians J.L. and Barbara Hammond. Such individuals embodied ‘deep-​rooted ethical and political strains within English culture’, hostile to the ‘dominant individualism in economic life’.They favoured promoting the collective good, being motivated by ‘an overarching moralism and conscience-​ driven form of politics’ underpinned by a version of history which ‘emphasized the socially damaging consequences of the triumph of commercialism’. The late 1940s saw the ‘culminating moment of this tradition’, when its adherents began to produce their main body of

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work. Titmuss and the others thus occupied ‘high places in the pantheon of this very English tradition of ethically driven progressive social commentary’.20 Hoggart is a revealing linkage here. His biographer records that Titmuss was his subject’s ‘hero’, whom he would quote approvingly.21 Hoggart himself, on the eve of New Labour’s 1997 election victory, claimed that the damage done by successive Conservative governments had to be reversed. Above all, this meant ‘reasserting the idea of a humane democracy’, best expressed in the twentieth century by Tawney,Titmuss, and George Orwell.This would lead to a society with ‘imaginative and moral texture, in which “I owe it to the community” once again replaces today’s favourite chant, “I owe it to the shareholders” ’.22 Freeden, Collini, and Hoggart capture key features of Titmuss’s beliefs –​the emphasis on both social and individual rights, concern with the outcomes of modernity, an organic view of society, and moral purpose based on mutual understanding and empathy. For Titmuss, the sort of society to be aimed for was one where, as he argued in The Gift Relationship, individuals came to love themselves through the love of others, a society which recognised, in the title of the pamphlet to which he contributed in the late 1950s, that we are Members One of Another. As Collini implies, this places Titmuss in a centuries old tradition of English radicalism. Halsey identified a ‘strand in British social criticism’ going back to the seventeenth century, ‘political arithmetic’, whose ethos was ‘inherited by the LSE in the 20th Century’. Titmuss was its ‘outstanding representative’ after 1945, ‘laying bare the vital statistics of social inequality’.23 What, then, did this English (not ‘British’) radicalism, with its early modern roots, embrace? For Allan Pond, its ‘particularities’ included an adherence to ‘empirical practice concerned with concrete results and the importance of the continuity between past, present and future society’. Such practice was favoured over ‘a theoretical doctrine that aims to control events through a claimed scientific understanding of future trends which must entail a sharp and irreversible rupture with the past’. It promoted, too, the ‘give and take of daily living as opposed to the abstract reasoning of professional lawyers or state functionaries or academic “experts” ’. In so doing, it opposed the ‘alliance of abstract reason and laissez-​faire principles’ which placed control of the political and economic dimension of ordinary people’s lives ‘in the hands of the new elites of welfare professionalism and corporate capital’. Finally, it encompassed an ‘unashamed popular patriotism’.24 To see Titmuss in such a tradition we need only remind ourselves of his low-​key, but undoubted, patriotism, historical approach, concerns

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about ‘welfare professionals’ and ‘experts’, scepticism about the claims of ‘orthodox’ economics and the virtues of economic growth, and hostility to over-​prescriptive, legalistic, welfare ‘rights’. Titmuss was not, as was noted during the LSE’s ‘Troubles’, an ‘orthodox’ Labour Party member, albeit, by this point, and as Freeden argues, broadly speaking in the social democratic camp. But he must also be seen as part of an older strand in progressive thought, stretching back through Edwardian New Liberalism to the Civil War era. It was from these foundations that Titmuss built his critique of, first, contemporary capitalism, and then of the ‘welfare state’. If Titmuss was a ‘socialist’, his was a socialism which had a moral, and not an economic, impetus, and to this extent his portrayal as an ‘heir’ to Tawney, another less than ‘orthodox’ Labour Party member, is not unreasonable. More immediately, Hoggart hit the nail on the head when, engaging with debates about affluence and the ‘welfare state’ in the late 1950s, he argued that Orwell would certainly have approved of post-​war social progress. Orwell would also have ‘appreciated sharply what Professor Titmuss and his group are trying to tell us about the appalling gaps in that Welfare State on which we excessively congratulate ourselves’.25 Titmuss would have agreed about excessive congratulation, but he did more than simply identify ‘appalling gaps’. He promoted policies to fill them, and do so in ways which promoted social solidarity, reduced inequalities, and recognised middle class ‘perks’ as ‘welfare’, though without the stigma associated with provision for the poor. Titmuss argued, too, that social policy should be flexible and adaptable. This leads to a problematic area of Titmuss’s ‘philosophy of welfare’. By the mid-​1960s he was beginning, to the dismay of some, to articulate a position where selection could play a positive part in welfare provision. This, when combined with his stance on ‘The Troubles’ at the LSE, and his membership of the great and good (or ‘The Establishment’, or Our Age), has led to suggestions of a move, towards the end of his life, politically rightwards. Three points can be made here. First, although his grasp of theoretical economics was probably weak, there is no sense that Titmuss thought that resources were infinite. Rather, the question was how those resources were allocated. Therefore, in certain circumstances, decisions based on selection had to be made. The key was to differentiate without stigma, Mike Miller’s formulation approvingly cited by Titmuss in Chicago in 1966. The need for some form of selectivity marked, for example, Titmuss’s work for the Finer Committee. For his critics, this marked a shift away from the universalism he had previously espoused (although they should perhaps have noted his stance on prescriptions, somewhat muddled though it was,

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and his argument, in the early days of the ‘welfare state’, on the need to identify ‘social priorities’). Selection might, then, be applied in the case of certain means-​tested benefits. This would enable discretion by the official determining payment, and on the part of the claimant, who would be left free to spend any award as they desired. Such a system gave agency to both parties, and was more flexible, and therefore more humane, than prescriptive, overly legalistic, welfare ‘rights’. Of necessity all this had to exist, for Titmuss, within the framework of universal provision. It is difficult to see, at first glance, why such a modest enabling of selection, and of individual agency, indicates a politically rightward move. However we need not accept every criticism made by, say,Townsend, to acknowledge that the system did not work as Titmuss wished. He was admirably supportive of both claimants and front-​line SBC staff, but that is not to say that the latter always carried out their responsibilities in an empathetic way. More fundamentally, any welfare system into which selection is built immediately lays itself open to the suspicion that the most vulnerable in society will, consciously or otherwise, be penalised for perceived misbehaviours, or even their very existence. Titmuss cannot be accused of advocating such a potentially hostile attitude to social service users, and his own proposals were intellectually coherent and a genuine attempt to address a central problem in welfare policy. If none of this necessarily signifies a move to the political right, it might nonetheless be seen as naïve in failing to confront the limits to even the most humane welfare regime. Second, what of ‘The Troubles’? Titmuss was, unquestionably, loyal to the LSE’s leadership throughout these disruptions, and was to form a close relationship with Walter Adams, whose appointment had started the unrest. Titmuss rejected what he saw as any curtailment of free speech or academic freedom. While sympathetic to some of the students’ complaints, and to individual students, ultimately he saw the protestors as a privileged section of the middle class, seduced by abstract theory rather than cognisant of social and political realities. Hence his comparison of the situation of students and that of SBC staff.Titmuss’s attitude to staff members supporting the protests was similarly robust. More positively, universities should have an integrative social function, recruit a more diverse student population, and engage more fully with fields and disciplines essential to the promotion of social solidarity and social wellbeing. Higher education was, after all, a form of welfare. So in this case Titmuss was an uneasy mixture of authoritarian and liberal, but again not necessarily moving rightwards. As was noted at the time, staff attitudes did not divide on predictable political lines.

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Finally, was Titmuss, by the time of his death, an ‘Establishment’ figure? The answer would have to be a qualified ‘yes’. From the 1930s onwards, he knew how to network, did it well, and benefited from the patronage of influential individuals. In turn, he, too, was able to exert considerable personal influence. He was a public figure who served on numerous bodies, had the ear of government ministers and senior civil servants, appeared frequently in various broadcast and print media (including The Times, mouthpiece of ‘The Establishment’), and actively supported high-​profile campaigns. Titmuss undoubtedly had a public voice, one he was prepared to use, and which commanded attention. The qualification is that he maintained, for the most part, a personally modest lifestyle, used such powers as he had to promote egalitarian and solidaristic ends, and was prepared to undertake the complex work this involved. In this respect, he was more a champion of the disadvantaged, less one of the great and good. Which returns us to his philosophy of welfare. Whether Titmuss produced a ‘philosophy’ in the strong sense of that word is debatable, but he certainly proposed a fairly coherent, if not complete or always consistent, view of what Social Policy was, and how it could be used to advance a less unequal, more morally responsible, society.This approach was extremely powerful in that it dominated the academic field which Titmuss had done so much to create, spreading beyond the LSE as that field expanded. Was it more broadly influential? Individuals as diverse as Annan, Crossman, and Seldon certainly thought so, notwithstanding that the Labour Party was, from the time of Titmuss’s LSE appointment, only in power for around seven years. Ultimately, direct influence is difficult to pin down, although Wilbur Cohen was happy to attribute it in his memorial service address. But it was certainly the case that Titmuss was increasingly instrumental in setting the terms of post-​war debates over social welfare, as is witnessed, negatively, by the reaction of bodies like the IEA. One area where Titmuss did appear to be lacking, even to some supporters, was around ‘theory’. In the early 1990s, Halsey praised The Gift Relationship as ‘perhaps the most dramatic post-​war expression’ of Tawney’s ‘socialist critique of capitalist society’. At the ‘level of sociological theory’, though,Titmuss was ‘perhaps more vulnerable’.26 The issue of ‘theory’ had been around for some time.Vaizey’s obituary stressed the ‘remarkable’ quality of Titmuss’s mind. But he was not in ‘any sense a model builder’. He had, moreover, ‘an historian’s deep distrust of economists and abstract thought on social matters’.27 Ten years later,Vaizey again acknowledged the power of Titmuss’s arguments while suggesting that they were, ultimately, not an ‘alternative social

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theory’, but rather an invented myth.28 Vaizey was by now well along his own political journey rightwards. But he had once been close to Titmuss, and could pinpoint certain weaknesses in his approach. Even before Titmuss’s death, this approach was being questioned by social scientists otherwise broadly sympathetic. Robert Pinker’s Social Theory and Social Policy, published in 1971, argued that his field lacked ‘that body of theoretical material which might give it a greater intellectual unity and perspective’. Titmuss had put forward a normative model of welfare which implied an ‘unambiguous conflict between the aims and values of social policy and the dominant ethos of capitalism’.29 Pinker later recalled that by the time he came to write this book he was becoming ‘increasingly disenchanted with Titmuss’s unitary model of social welfare’. This was, ultimately, based on ‘a sharply drawn distinction between egoism and altruism’, bearing ‘little or no relationship to what we know about human nature and the realities of the world in which we live’.30 These ‘realities’ were also picked up by Frank Field. Field’s attack is all the more revealing in coming from someone not only on the centre-​ left but who had also worked for the CPAG and the Low Pay Unit, both of which were, from the outset, critical of aspects of Titmuss’s approach. In 1997 Field rejected the idea that welfare policy could be based on altruism, this ‘Titmuss world’ being ‘built on sand’. Dismissing the idea of Titmuss as Tawney’s successor, Field notes that the latter (like Field) was a Christian, and hence a believer in humanity’s fundamentally flawed nature. ‘Titmuss held a view totally at variance with Tawney’s stance. The fallen side of mankind was written out of the Titmuss script.’ This was not merely an academic matter, for Titmuss’s ‘sanitised post-​Christian view of human character’ led to ‘an approach to welfare which helped make Labour unelectable for so much of my political career’, with the Titmuss ‘legacy’ being ‘as dangerous as it is futile’. Worse still, the Titmuss paradigm’s dominance had resulted in the Labour Party succumbing to a sort of intellectual paralysis which had, from the 1970s, handed neo-​liberalism the advantage. Titmuss, and his followers, had established ‘a post-​war orthodoxy which, while beneficial in the age of the rationbook, became an intellectual, political and moral cul-​de-​sac into which Labour was manoeuvred during so much of the latter post-​war period’. Altruism had been made the ‘cornerstone of the post-​war welfare state by the LSE ideologues.The travail into which this approach has led the political debate is there for all who choose to see it’.31 These critics pointed to, variously, Titmuss’s misunderstanding of human psychology, the consequent dangers inherent in a welfare

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strategy centred on altruism, and the political consequences of an approach apparently over-​sympathetic to welfare recipients (something particularly stressed by Field). Such critiques are part of a huge volume of literature on how those involved with the social services, as providers or recipients, behave.32 And it hardly needs pointing out that attitudes towards welfare claimants continue to inform certain types of political discourse in the twenty-​first century. As to ‘theory’, though, we have seen that Titmuss was sceptical about what he saw as abstract thought lacking empirical grounding. Nonetheless, he has been accused of failing to produce an approach intellectually robust enough to see off neo-​liberalism. But to put a different spin on this, Titmuss consistently claimed that, in a rapidly changing society, new questions would always arise, hence the need for flexibility in welfare policy, and in thinking about welfare policy. Titmuss’s historical approach likewise militated against sociological and economic abstractions. And he was, usually, careful to suggest that his was not necessarily the last word, although some supporters were inclined to such a view. There is a further twist here. Pinker records that few Social Policy scholars saw any threat from the IEA, but that ‘Titmuss was the exception, and subsequent events proved him right’.33 This, though, raises a further question –​why, given his status, did Titmuss’s warnings go unheeded?

Titmuss in the twenty-​first century Collini remarks that, while pre-​eminent in his field during his lifetime, since Titmuss’s death ‘he has not had anything like the name recognition enjoyed by other leading intellectuals and academics of his generation’.34 Jerry Morris, at a symposium in 2000, reiterated his affection and admiration for Titmuss, appearing upset when recollecting his close friend. Revealingly, he noted that ‘in today’s extraordinary proceedings one person who has scarcely been mentioned’ was Titmuss.35 This was worthy of comment as the meeting discussed epidemiology, social medicine, and public health –​subjects to which Titmuss had made important contributions. All this might be seen as further evidence of the demise of his ‘philosophy of welfare’, and of a more general fading out of the picture. Titmuss still commands attention, though. In 2009, reflecting on the fiftieth anniversary of ‘The Social Division of Welfare’, Kirk Mann asserted its continuing relevance and ‘analytical potential’, especially at a time when ‘the rich zip by on the escalator of growth’ while ‘the poorest must try to clamber up a precarious “ladder of opportunity” ’.36 At a meeting in 2013 marking the fortieth anniversary of Titmuss’s

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death, Adrian Sinfield argued for the ongoing importance of his work, again especially in the areas of fiscal and occupational welfare.37 Six years later, Sinfield reported that state subsidies to pension schemes remained ‘little recognised in the social policy literature and broader policy making’, notwithstanding the case made by Titmuss decades previously.38 This can, of course, be read in two ways: Sinfield’s continuing admiration for Titmuss’s insights, alongside their more general neglect. Also in 2013, Howard Glennerster suggested that Titmuss had produced ‘a compelling framework of middle ground ideas that has effectively evolved over forty years’. As such, these ideas were ‘robust over time’.39 It is notable that those cited have been eminent in the field of Social Policy.Worth noting, too, is the respectable rating Titmuss achieved in a bibliometric analysis seeking to identify those who had had a particular impact on the field.40 And while Titmuss’s methods may have had their limitations, nonetheless his commitment to empirical evidence remains commendable. To take one example of Titmuss’s ongoing influence, half a century on The Gift Relationship remains a reference point for debates about the relationship between the market and desired ethical outcomes. Michael Sandel, Harvard philosopher and public intellectual, has promoted Titmuss’s arguments about blood and morality, for instance in his 2009 BBC Reith Lecture, ‘Markets and Morals’.41 In 2012 he likewise noted that the ‘best-​known illustration of markets crowding out non-​market norms’ was that ‘classic study of blood donation’, The Gift Relationship.Titmuss had provided an ethical case against the selling of blood, and his argument illustrated ‘the two objections to markets … –​fairness and corruption’. The market in blood ‘exploits the poor (the fairness objection)’, while blood as a commodity eroded ‘people’s sense of obligation to donate blood’, diminished the ‘spirit of altruism’, and undermined the ‘ “gift relationship” as an active feature of social life (the corruption objection)’. Sandel acknowledged the counter-​ arguments, for example that altruism was a resource which might diminish over time. But characteristics such as altruism, generosity, solidarity, and civic spirit were not ‘like commodities that are depleted with use’. Rather, they were like muscles which grew and developed the more they were exercised.42 This could have been argued by Titmuss himself. In 2013, The Lancet carried a special report on blood transfusion, suggesting that one way to ensure its proper use was to ‘join the celebration of the altruism of voluntary unpaid donors, as described so eloquently in The Gift Relationship’.43 In 2018 The Economist noted the huge market in blood products and how, wrongly in its view, some countries persisted in banning their acquisition by way of payments to

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donors.This ‘stigma’ went back to The Gift Relationship, and ‘prejudice and misconception’ had led to overreliance on the United States as a supplier.44 The point here is not the rejection of Titmuss, but that he was cited in the first place.45

‘A way of looking at the world’ An unexpected pleasure in researching this volume has been the opportunity to meet individuals who knew Titmuss personally. One, the late David Donnison, casually remarked, at the end our first conversation, that, when pondering contemporary issues, he often found himself wondering ‘what would Richard think?’46 Another interviewee, Jose Harris, stressed how original Problems of Social Policy was in its approach to historical writing and interpretation.47 In the discussion following a paper given by the present author, Adrian Sinfield suggested that Titmuss’s particular contribution was ‘a way of looking at things’.48 Others, too, have commented on this aspect of Titmuss’s approach. In the mid-​1980s, Jerry Morris remembered his old friend as ‘an original … different from other people … and … a real research man’.49 The notion of such an angular approach was noted by Vaizey when he proposed that, like his close friend Tawney, Titmuss’s influence lay not in terms of policy impact, but rather in ‘a way of looking at the world, which is now part of the world view of most people concerned with social policy’.50 Another obituarist, David Piachaud, remarked that Titmuss’s strengths were as a ‘teacher and scholar’ who always asked ‘the right question’.51 More ambiguously,Townsend recorded in 1956, that is near the beginning of their association, that Titmuss ‘asks questions about things everybody else accepts. It is this and his integrity, rather than mental brilliance and dexterity, which makes him the one surgeon under whom I want to practice’.52 And, as we have seen, Abel-​Smith praised Titmuss’s ‘remarkable ability’ to ‘identify the really important questions’, Norman McKenzie lauded his skill at seeing problems in ‘a fresh light’, and Eileen Younghusband spoke of his bringing ‘a new dimension to this generation’s thought’. From across the Atlantic, meanwhile, Karl de Schweinitz told Titmuss that he had the ‘rare ability’ to bring together ‘facts and ideas which hitherto no one has recognised as being related to each other’. Ultimately, Titmuss’s sceptical, challenging, original perspective may be what was most important about him. In this volume we have encountered his prodigious workload in a range of activities. But his singularity lies in the sort of questions he asked, his unwillingness to accept received wisdom, and his imaginative analyses of social issues.

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We know that ‘The Social Division of Welfare’ retains its appeal for social policy analysts. Its originality lay, of course, in identifying tax and employment benefits to the middle class as forms of welfare which were not generally perceived as such, especially when compared with state-​provided social services.The latter constituted the popular perception of the ‘welfare state’, with all the rhetorical, and political, baggage that phrase brought with it. The irony, as Titmuss relentlessly pointed out, was that fiscal, occupational, and state-​provided welfare might each be pursuing similar ends, for example support for families, but were accounted for, and accommodated, in different ways. In The Gift Relationship he argued, in the face of conventional economic wisdom, that the exercise of altruism was morally superior, and economically more efficient, in acquiring supplies of blood. It is not being suggested that Titmuss was routinely right, that all his prescriptions have stood the test of time, or that his distinctive, angular, approach always came off.We need to recognise, too, that the world in which he operated has changed dramatically. In social welfare, to take very obvious examples, since Titmuss’s death successive governments have sought to introduce managerialist, or market, approaches to the NHS, while local government has been stripped of many welfare functions.The use of foodbanks, a previously unknown phenomenon, by both welfare recipients and those in poorly paid employment is now commonplace. One of the few upsides here is that foodbanks are expressions of voluntarism and altruism. Paradoxically, though, this suggests, at least for what remains of the liberal left, that the gains to be made from using Titmuss as a prism through which to see contemporary society. So we might continue to ask, as he did, what are the implications (including the environmental implications) of the relentless pursuit of economic growth at the expense of social growth, how do we tackle inequality and the resurgence of poverty, and how might we promote a more socially cohesive society? In the early decades of the twenty-​first century we could do worse than look to Richard Titmuss not so much for fixed solutions to particular problems, but rather to his way of seeing the world. Despite his faults and failings, we might celebrate him as someone who had a clear vision of a better society, how it might be achieved, and worked tirelessly to that end. Notes 1 TITMUSS/​4/​558, letter, 7 April 1964, Derek J.G. Holroyde, Senior Producer –​ Tuesday Term (Talks Group) to RMT; and Typescript for Programme II, pp 1–​2. 2 R.M. Titmuss, ‘Welfare State and Welfare Society’, in Commitment to Welfare, pp  124–​5.

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A commitment to welfare: the life and work of Richard Titmuss 3 N. Annan, Our Age: Portrait of a Generation, London, Weidenfeld and Nicholson, 1990, p 12. 4 J. Vaizey, In Breach of Promise, London, Weidenfeld and Nicholson, 1983, pp 58, 61, 67, 68. 5 A.H. Halsey, No Discouragement:  An Autobiography, Basingstoke, Macmillan, 1996, p 215. 6 Annan, Our Age, p 256. 7 TITMUSS/​4 /​5 58, letter, 17 August 1964, Bute Hewes, Editor, Special Programmes, ITN, to RMT. 8 TITMUSS/​7/​74, letters, undated but January 1966, Marquand to RMT; and 3 January 1966, RMT to Marquand. 9 Oakley, Father and Daughter, p 244. 10 Author interviews with Professors Adrian Sinfield, 9 January 2016, and Pat Thane, 9 March 2016. 11 Oakley, Father and Daughter, pp 244–​5. 12 For instance, Professor David Piachaud, interviewed by the author, 12 January 2016, claimed that at the time of his appointment in 1970, the department was still seen as being concerned with ‘good works’, and especially despised by economists. 13 TITMUSS/​7/​40, letter, 7 August 1970, Williams to RMT. 14 Discussion with Professor Ann Oakley, December 2019. 15 Oakley, Father and Daughter, pp 175–​8, and passim; Oakley, Taking it Like a Woman, pp 104–​12. 16 Titmuss, ‘Planning for Ageing and the Health and Welfare Services’, p 91. 17 D. Kynaston, Family Britain, London, Bloomsbury, 2009, pp 77–​8. 18 M. Freeden, ‘Civil Society and the Good Citizen: Competing Conceptions of Citizenship in Twentieth Century Britain’, in J. Harris (ed), Civil Society in British History:  Ideas, Identities, Institutions, Oxford, Oxford University Press, 2003, pp 286–​90. 19 M. Freeden, Liberal Languages:  Ideological Imaginations and Twentieth-​Century Progressive Thought, Princeton, NJ, Princeton University Press, 2005, pp 182–​3, 139. 20 S. Collini,‘Moralists’, in S. Collini, Common Writing: Essays on Literary Culture and Public Debate, Oxford, Oxford University Press, 2016, p 182. 21 F. Inglis, Richard Hoggart: Virtue and Reward, London, Polity Press, 2014, pp 216–​17, 247, 243. 22 ‘What This Country Needs Is…’, New Statesman, 27 March 1997, p 23. 23 Halsey, No Discouragement, p 57. 24 A. Pond, ‘Beyond Memory’s Reach: The Particularities of English Radicalism’, The Quarterly Review, Winter 2008, pp 27, 32. 25 R. Hoggart, ‘Looking Back at Orwell’, The Guardian, 29 May 1959, p 6. 26 Halsey, No Discouragement, pp 106–​8. 27 J. Vaizey, ‘Richard Titmuss:  An Appreciation’, The Financial Times, 10 April 1973, p 15. 28 Vaizey, In Breach of Promise, pp 56–​7. 29 R. Pinker, Social Theory and Social Policy, London, Heinemann, 1971, pp 5, 102. 30 R. Pinker, ‘From Gift Relationships to Quasi-​Markets:  An Odyssey Along the Paths of Altruism and Egoism’, Social Policy and Administration, 40, 1, 2006, pp 17, 19. 31 F. Field, ‘Frank Field’s Response to Alan Deacon’, in A. Morton (ed), The Future of Welfare, Edinburgh, Centre for Theology and Public Issues, 1997, pp 150, 151,

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RICHARD TITMUSS 152, and passim. I am grateful to Frank Field MP for alerting me to this, and other, publications, and for an interview, 5 November 2015, which further confirmed the points made earlier. 32 See, as an introduction to a complex topic, J. Le Grand, Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens, Oxford, Oxford University Press, 2003. 33 Pinker, ‘From Gift Relationships’, p 11. 34 Collini, Common Writing, p 200. 35 V. Berridge and S.  Taylor (ed), Epidemiology, Social Medicine and Public Health, London, Centre for History in Public Health, LSHTM, 2005, p 39. I owe the point about Morris’s emotional state to an informal conversation with Professor Virginia Berridge, LSHTM, 9 March 2017. 36 K. Mann, ‘Remembering and Rethinking the Social Divisions of Welfare: 50 Years On’, Journal of Social Policy, 38, 1, 2009, pp 1, 14. 37 A. Sinfield, ‘Why Do We Need to Keep Reading Titmuss?’, paper given to the Symposium ‘Richard Titmuss Forty Years On’ at the Social Policy Association conference, 2013. Professor Sinfield kindly sent me a copy of this talk. 38 A. Sinfield, ‘The Benefits and Inequalities of Fiscal Welfare’, in M.  Powell (ed), Understanding the Mixed Economy of Welfare, Bristol, Policy Press, 2nd edn 2019, p 147. 39 H. Glennerster, Richard Titmuss Forty Years On: Case/​180, Centre for Analysis of Social Exclusion, LSE, 2014, p 10. 40 M. Powell, ‘Social Policy’s “Greatest Hits” ’, Social Policy and Administration, 52, 5, 2018, pp 1126–​38. I am grateful to Professor Powell for his further insights into this survey. 41 Available at www.bbc.co.uk/​programmes/​b00kt7sh 42 M. Sandel, What Money Can’t Buy: The Moral Limits of Markets, London, Penguin Books, 2012, pp 122, 123–​4, 130. 43 ‘Editorial’, The Lancet, 381, 25 May 2013, p 1789. 44 Leader, ‘Blood Money’, and article, ‘Thicker than Water’, The Economist, 12 May 2018, pp 12–​14, and 55–​6. I am grateful to Professor Ann Oakley for this reference. 45 For further examples of twenty-​first century references to The Gift Relationship, see J. Stewart,‘New Introduction’, in R.M.Titmuss, The Gift Relationship, Bristol, Policy Press, 2018. 46 Author interview, Professor David Donnison, 4 December 2015. 47 Author interview, Professor Jose Harris, 18 July 2016. 48 Discussion following paper to School of Social and Political Science, University of Edinburgh, 17 May 2018. 49 ‘Professor Jerry Morris in Interview with Max Blythe, 9 May 1986’, typescript of The Royal College of Physicians and Oxford Brookes University Medical Sciences Video Archive MSVA 008, p 9. 50 Vaizey, ‘Richard Titmuss: An Appreciation’, p 15. 51 D. Piachaud,‘Titmuss –​Teacher and Thinker’, New Statesman. 13 April 1973, p. 521. 52 Cited in H. Glennerster,‘Peter Brereton Townsend 1929–​2009’, Proceedings of the British Academy,Vol 172, Biographical Memoirs of Fellows, X, accessed online.

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Publications by Richard Titmuss cited in this volume (not including letters to the press, editorials, typescripts/​drafts and book reviews) Books Poverty and Population, London, Macmillan, 1938. Our Food Problem:  A Study of National Security, Harmondsworth, Penguin Books, 1939 (with F. Le Gros Clark). Parents Revolt: A Study of the Declining Birth-​Rate in Acquisitive Societies, London, Secker and Warburg, 1942 (with K. Titmuss). Birth, Poverty and Wealth: A Study of Infant Mortality, London, Hamish Hamilton Medical Books, 1943. Report on Luton, Luton, The Leagrave Press, 1945 (with F. Grundy). Problems of Social Policy, London, HMSO, 1950. The Cost of the National Health Service in England and Wales, Cambridge, Cambridge University Press, 1956 (with B. Abel-​Smith). Social Policies and Population Growth in Mauritius, London, Methuen and Co, 1961 (with B. Abel-​Smith, and assisted by T. Lynes). The Health Services of Tanganyika: A Report to the Government, London, Pitman Medical, 1964 (with B.  Abel-​S mith, G.  Macdonald, A. Williams, and C. Wood). The Gift Relationship: From Human Blood to Social Policy, London, George Allen and Unwin, 1970. The Gift Relationship:  From Human Blood to Social Policy, New York: Pantheon Books, 1971. Social Policy: An Introduction, London, George Allen and Unwin (ed B. Abel-​Smith and K. Titmuss).

Essay collections Essays on ‘The Welfare State’, London, Allen and Unwin, 1958. Essays on ‘The Welfare State’, London, Unwin University Books, 2nd edn 1963, includes The Irresponsible Society. Essays on ‘The Welfare State’, London, George Allen and Unwin, 3rd edn 1976. Essays on ‘The Welfare State’, Bristol, Policy Press, 2018.

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Commitment to Welfare, London, George Allen and Unwin, 1968. Commitment to Welfare, New York, Pantheon Books, 1968.

Essays in edited collections and reports/​pamphlets Problems of Population: Handbooks for Discussion Groups, No 9, London, Association for Education in Citizenship, 1943 (?). ‘The Statistics of Parenthood’, in Sir J. Marchant (ed), Rebuilding Family Life in the Post-​War World, London, Odhams, 1945, pp 7–​24. ‘War and Social Policy’, in Essays on ‘The Welfare State’, pp 75–​87. ‘The Position of Women: SomeVital Statistics’, in Essays on ‘The Welfare State’, pp 88–​103. ‘Some Fundamental Assumptions’, Old Age in the Modern World: Report of the Third Congress of the International Association of Gerontology, London 1954, Edinburgh, E. & S. Livingstone, 1955, pp 45–​9. The Social Division of Welfare:  Eleanor Rathbone Memorial Lecture, Liverpool, Liverpool University Press, 1956. Reprinted in Essays on ‘The Welfare State’, pp 34–​55. ‘The National Health Service in England: Some Aspects of Structure’, in Essays on ‘The Welfare State’, pp 133–​51. ‘The National Health Service in England: Some Facts about General Practice’, in Essays on ‘The Welfare State’, pp 152–​77. ‘The National Health Service in England: Science and the Sociology of Medical Care’, in Essays on ‘The Welfare State’, pp 178–​202. The Irresponsible Society:  Fabian Tract 323, London, The Fabian Society, 1960. ‘Introduction’, R.H. Tawney, Equality, London, George Allen and Unwin, new edn 1964, pp 9–​24. ‘Planning for Ageing and the Health and Welfare Services’, in R.M. Titmuss, Commitment to Welfare, pp 91–​103. ‘Health’, in M. Ginsberg (ed), Law and Opinion in England in the Twentieth Century, London, Stevens and Sons, 1959. Reprinted in Commitment to Welfare, pp 228–​46. ‘Sociological and Ethnic Aspects of Therapeutics’, in P. Talalay (ed), assisted by J.H. Murnaghan, Drugs in Our Society, Baltimore,The Johns Hopkins University Press, 1964, pp 243–​53. Reprinted in Commitment to Welfare, pp 218–​27. The Welfare State: Objectives in Israel: Reflections on Britain: Pamphlet no 7, London, The Anglo-​Israel Association, 1965. ‘Social Policy and Economic Progress’, in National Conference on Social Welfare, The SocialWelfare Forum, 1966, New York, Columbia University Press, 1966. Reprinted in Commitment to Welfare, pp 153–​165.

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‘Goals of Today’s Welfare State’, in P.  Anderson and R.  Blackburn (eds), Towards Socialism, Ithaca, NY, Cornell University Press, 1966, pp 354–​65. ‘Postscript to Ethics and Economics of Medical Care, August 1967’, in Commitment to Welfare, pp 263–​8. ‘Time Remembered’, in Commitment to Welfare, pp 50–​51. ‘Welfare State and Welfare Society’, in Commitment to Welfare, pp 124–​37. ‘The Subject of Social Administration’, in Commitment toWelfare, pp  13–​24. ‘Models of Redistribution in Social Security and Private Insurance’, in Commitment to Welfare, pp 173–​87. ‘Planning for Ageing and the Health and Welfare Services’, in Commitment to Welfare, pp 91–​103. ‘The University and Welfare Objectives’ and ‘Concluding Remarks’ in I. Katz and H. Silver (eds), The University and Social Welfare, Jerusalem, The Hebrew University, 1969. Reprinted in Commitment to Welfare, pp  25–​36. ‘The Culture of Medical Care and Consumer Behaviour’, in F.N.L. Poynter (ed), Medicine and Culture, London,Wellcome Institute of the History of Medicine, 1969, pp 129–​37. ‘The Right to Social Security’, in R.M. Titmuss and M.  Zander, Unequal Rights, London, CPAG, 1968, pp 7–​10. Choice and the ‘Welfare State’, London, The Fabian Society, 1967. Reprinted in Commitment to Welfare, pp 138–​52. ‘New Guardians of the Poor in Britain’, in S.  Jenkins (ed), Social Security in International Perspective: Essays in Honor of Eveline M. Burns, New York, Columbia University Press, 1969, pp 151–​64. ‘Social Security and Health’, Encyclopedia Americana:  International Edition: Vol 13, New York, Americana Corporation, 1971 (with M.J. Reddin), pp 251–​4.

Articles in journals/​newspapers ‘Man-​Power and Health’, The Spectator, 26 May 1939, pp 896–​7. ‘Can the Poor Save?’, The Spectator, 23 February 1940, pp 224–​5. ‘The Cost of Living and Dying’, The New Statesman and Nation, 5 April 1941, p 357. ‘Planning and the Birth-​rate’, Town and Country Planning, XI, 33, 1941, pp  83–​5. ‘Eugenics and Poverty’, Eugenics Review, 33, 4, January 1942 (with F. Lafitte), pp 106–​12. ‘The Effect of the War on the Birth Rate’, Eugenics Review, 34, 1, April 1942, p 12.

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‘Recent German Vital Statistics’, The Lancet, II, 1942, p 434. ‘Epidemiology of Juvenile Rheumatism’, The Lancet, II, 1942, pp 59–​63 (with J.N. Morris). ‘The Significance of Recent Birth-​Rate Figures’, Eugenics Review, 35, 2, July 1943, pp 36–​8. ‘Fewer Children: The Population Problem’, Current Affairs, No 83,The Army Bureau of Current Affairs, December 2nd 1944 ‘The Social Environment and Eugenics’, Eugenics Review, 36, 2, July 1944, pp 53–​8. ‘Health and Social Change I:  The Recent History of Rheumatic Heart Disease’, The Medical Officer, Aug/​Sept 1944, pp 69–​71 (with J.N. Morris). ‘Epidemiology of Peptic Ulcer: Vital Statistics’, The Lancet, II, 1944, pp 841–​55 (with J.N. Morris). ‘Parenthood and Social Change’, The Lancet, II, 1948, pp 797–​9. ‘Social Administration in a Changing Society’, British Journal of Sociology, 2, 3, 1951, pp 183–​97. Reprinted in Essays on ‘The Welfare State’, pp  13–​33. ‘The Hospital and its Patients’, The Hospital, June 1952, pp 417–​25. Reprinted in Essays on ‘The Welfare State’, pp 119–​32. ‘The Cost of Medical Care:  American Experience and the NHS’, Lancet, I, 1952, pp 605–​6. ‘The Age of Pensions I –​Public Service Provision for Retirement’, The Times, 29 December 1953, p 7. ‘The Age of Pensions II –​Superannuation and Social Policy’, The Times, 30 December 1953, p 7. ‘Industrialization and the Family’, Social Service Review, 31, 1, 1957, pp 54–​62. Reprinted in Essays on ‘The Welfare State’, pp 104–​18. ‘Community Care as Challenge’, The Times, 12 May 1959, p 11. ‘Ethics and Economics of Medical Care’, Medical Care, 1, 1, 1963, pp 16–​22. Reprinted in Commitment to Welfare, pp 247–​68. ‘The New Language of Inequality’, New Statesman, 21 September 1962, pp 354–​5. ‘Care –​or Cant?’, The Spectator, 17 March 1961, pp 354–​5. Reprinted in H. Freeman and J. Farndale (eds), Trends in the Mental Health Services, Oxford, Pergamon Press, and in Commitment to Welfare, pp 104–​9. ‘The Limits of the Welfare State’, New Left Review, 1/​27, Sept/​Oct 1964, pp 28–​37. ‘Role of the Family Doctor Today in the Context of Britain’s Social Services’, The Lancet, I, 1965, pp 1–​4. ‘The Relationship between Schools of Social Work, Social Research, and Social Policy’, International Social Work, 4, 1, 1965, pp 4–​9. Reprinted in Commitment to Welfare, pp 37–​47.

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‘Poverty vs. Inequality:  Diagnosis’, The Nation, 8 February 1965, pp  130–​3. ‘The Role of Redistribution in Social Policy’, Social Security Bulletin, 1 June 1965, pp 14–​21. Reprinted in Commitment to Welfare, pp 188–​99. ‘Child Endowment Reappraisal’, The Times, 4 October 1965, p 11 and ‘Plan for Children in Poverty’, The Times, 5 October 1965, p 11. Reprinted as ‘Child Poverty and Child Endowment’, in Commitment to Welfare, pp 166–​72. ‘Social Work and Social Service: A Challenge for Local Government’, Journal of the Royal Society of Health, January 1966, pp 19–​21. Reprinted in Commitment to Welfare, pp 85–​90. ‘The Welfare Complex in a Changing Society’, The Milbank Memorial Fund Quarterly, 45, 1, 1967, pp 9–​23. Reprinted in Commitment to Welfare, pp 72–​84. ‘Universal and Selective Social Services’, New Statesman, 15 September 1967, pp 308–​10. Reprinted in Commitment to Welfare, pp 113–​23. ‘The Relationship between Social Security Programmes and Social Security Benefits: An Overview’, International Social Security Review, 20, 1, 1967, pp 57–​66, reprinted in Commitment to Welfare, pp  59–​71. ‘Trading in Human Capital’, Science Journal, 3, 6, June 1967, p 3. ‘Universal or Selective? The Practical Case against the Means-​Test State’, New Statesman, 15 September 1967, pp 308–​10. Reprinted in Commitment to Welfare, pp 113–​23. ‘The Great Poverty Muddle’, The Guardian, 29 October 1970, p 13. ‘Welfare “Rights”, Law and Discretion’, Political Quarterly, 42, 2, 1971, pp 113–​32.

Prefaces/​forewords ‘A Commentary’, in Sir H.N. Bunbury (ed), Lloyd George’s Ambulance Wagon: Being the Memoirs of William J. Braithwaite, 1911–​1912, London, Methuen, 1957. ‘Preface’ in Titmuss, Essays on ‘The Welfare State’. ‘Foreword’, in J.P. Martin, Social Aspects of Prescribing, London, William Heinemann, 1957. ‘Foreword’, in M. Raphael, Pensions and Public Servants: A Study of the Origins of the British System, Paris, Mouton and Co, 1964, pp 13–​17. Reprinted in Commitment to Welfare. ‘Foreword’, in P. Jephcott, N. Seear, and J.H. Smith, Married Women Working, London, George Allen and Unwin, 1962. ‘Foreword’, in J. Vaizey, The Costs of Education, London, George Allen and Unwin, 1958.

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‘Foreword’, in A. Forder, Social Casework and Administration, London, Faber and Faber, 1966. ‘Preface’, in S. Mencher, Private Practice in Britain: The Relationship of Private Medical Care to the National Health Service: Occasional Papers on Social Administration no 24, London, G. Bell and Sons, 1967. ‘Preface’, in Titmuss, Commitment to Welfare. ‘Preface’, in G. Taylor and N. Ayres, Born and Bred Unequal, London, Longman, 1969.

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Frequently cited secondary sources R. Dahrendorf, A History of the London School of Economics, 1895–​1995, Oxford, Oxford University Press, 1995. A. Oakley, Man and Wife: Richard and Kay Titmuss: My Parents’ Early Years, London, Flamingo, 1997. A. Oakley, Father and Daughter:  Patriarchy, Gender and Social Science, Bristol, Policy Press, 2014. S. Sheard, The Passionate Economist: How Brian Abel-​Smith Shaped Global Health and Welfare, Bristol, Policy Press, 2014.

565

Archival sources* TITMUSS

Richard Titmuss Papers, BLPES

TITMUSS/​AO

Richard Titmuss Papers held by Professor Ann Oakley

JEGER

Lena Jeger Papers, BLPES

FINER

Papers of the Finer Committee on One-​Parent Families, BLPES

LSE

Papers of the London School of Economics, BLPES

LSE/​Staff Files/​ Titmuss

Richard Titmuss’s Personnel Files, London School of Economics

CROSSMAN

Richard Crossman Papers, Modern Records Centre, University of Warwick

ALLEN

Marjory Allen Papers, Modern Records Centre, University of Warwick

YOUNGHUSBAND Eileen Younghusband Papers, Modern Records Centre, University of Warwick COHEN

Wilbur J. Cohen Papers, Wisconsin Historical Society

EUGENICS

Eugenics Society Papers, Wellcome Library, London

PIC

Population Investigation Committee Papers, Wellcome Library, London

LPA

Labour Party Archives, People’s Museum, Manchester

HART

Judith Hart Papers, People’s Museum, Manchester

CREECH JONES

Arthur Creech Jones Papers, Bodleian Library, Oxford

MORRIS

Jerry Morris Papers, London School of Hygiene and Tropical Medicine

AHA

Archives of the American Hospital Association, Chicago

NRS

National Records of Scotland, Edinburgh

TNA

The National Archives, Kew, London

* In all of these Titmuss is referred to as ‘RMT’.

566

Index A Abbott, Edith  407 Abel-​Smith, Brian  10, 19, 166, 295, 433, 555 on Commitment to Welfare  365 emigration of doctors  301 Essays on ‘The Welfare State’  251–​2 Guillebaud Committee  194–​6, 199, 202, 376, 390, 392 Irresponsible Society  262, 264 and Israel  316 loyalty to Titmuss  545 LSE disruption  509 and Mauritius  308 and pensions policy  213–​15, 217–​20 on Philosophy of Welfare  435 ‘poverty lobby’  441, 442, 443, 445 on relative poverty  257 Social Policy: An Introduction  423 and Tanganyika  307, 311 Titmuss memorial  531–​3 ‘Tuesday Term’  541 Aberdeen field study  148 abstract theory  519, 550 Abyssinia  36, 38 academic freedom  515–​16 academic life and gender  10 Acheson, A.B  87–​9 Acland, Sir Richard  37, 44, 45, 46, 117 Unser Kampf (Our Struggle)  43 acquisitive society  33, 73–​7, 129, 132, 139 Acquisitive Society  75, 176, 273, 275 Adams, Walter  507–​9, 525 Addams, Jane  427 Addison, Paul  178 Advisory Council on the Status of Women  416 affluence  76, 115, 279, 546 Affluent Society  5, 164, 256, 273, 278 African Americans  404, 413, 415, 419, 448 African Medical and Research Foundation  311 African socialism  313, 315 Afro-​Asian Institute  318 ageing population  196, 208, 425 Age of Pensions  209 Aid for Families with Dependent Children  404, 430 Albert Einstein College of Medicine  498 Alden, Percy  139

Allen, Lady Marjory  95, 96, 97 altruism  6, 46, 483, 497, 501, 546 AMA  see American Medical Association (AMA) Ambros, M.V  62–​3 America  13, 58, 72, 143, 279–​80 foreign policy  468 healthcare and social reform  380, 392, 403–​5 influence in  369–​71, 372–​5, 423, 434 scholars  387–​90, 423 social work  229, 246 American Foundation  397 American League for Industrial Democracy  266 American Medical Association (AMA)  376, 380, 393, 404, 484 Anderson, J.A.D (Jock)  295 Anderson, Odin W  383, 397–​9, 489 Anderson, Perry  515 Anderson, Sir John  63 Anglo-​Israel Association  321 Annan, Noel  158, 517 Our Age  542 Anti-​Apartheid Movement  313, 471 antibiotics  198 apartheid  10 appeal tribunals  463 appeasement  37 Applied Social Studies  227, 232, 236, 240, 244, 245 Aran, Zalman  320 Arden House Conference on Social Policy  380–​1 arms expenditure  12 Armstrong, P  242 Army Bureau of Current Affairs (ABCA)  127 army education  127 army recruits, health of  40, 63–​5 Ashdown, Margaret  230 Ashton, T.S  274 Association for Education in Citizenship  52, 126 Athenaeum, The  53, 100 Attlee, Clement  42, 94, 162, 176, 191, 275 audience, reaching an  60, 69–​72, 125, 268, 480, 551 automation, impact of  5, 164, 183, 412, 546 Aves, Geraldine  234, 336, 338 Ayer, A.J  467

567

RICHARD TITMUSS

B Baird, Professor  148 Ball, Kenneth  526 Ball, Robert  383, 407 Balogh, Thomas  445, 544 Banks-​Smith, Nancy  527 Barnett, Henry  498 Barry, Gerald  41 Bartlett, Professor Sir Frederick  157 Bateson, Nicholas  509 Battle for Health: A Primer of Social Medicine  146 Battle of Cable Street  34 BBC  121, 131–​5, 160, 193, 281 ‘From the Cradle to the Grave’  527 Panorama: Poverty in Britain  443 Reith Lecture  554 ‘Woman’s Hour’  134 Bedford College  350, 355 Beeley, Arthur  275 behavioural science  230, 299 Bell, Daniel  497 End of Ideology: On the Exhaustion of Political Ideas in the Fifties  279–​80 Benedict, Ruth  162 benefits  94, 165, 205, 444–​5, 449 see also Supplementary Benefits Commission Benn, Anthony Wedgwood  258, 279 Bevan, Aneurin  191–​2, 199 Beveridge, Sir William  51, 177, 208–​9 Beveridge Report  45, 56, 102–​3, 112, 127, 128 Bibby, Cyril  119, 510 Birnbaum, Norman  253 Birth, Poverty and Wealth: a Study of Infant Mortality  45, 109, 115–​18 birth control  52, 115, 127, 138, 140 birth rate, declining  72, 113, 132, 134 see also population Blackburn, Robin  509, 513, 515 Blacker, C.P  56, 109, 113, 114, 115, 116 Blackett, Patrick  4, 543 blackshirts  34 Blackstone, Tessa  507, 514, 518 Bland, Lucy  53 blood donations  432, 483, 489–​93, 554 see also Gift Relationship Bohm, Anne  526 Booth, Charles  207 Bowlby, John  33 Bowley, A.L  159 Boyd-​Carpenter, John  220, 221, 222 Boyd Orr, John  41, 55 Bradford Hill, Austin  524 ‘brain drain’  301

Bramwell, Byrom  115 Brandeis University  408 Branscombe, Martha  321 Brewster, Agnes  382 Bridean, The  36 British Academy Fellowship  9, 524 British Committee for Jews in Arab Countries  325 British Empire and Colonies  27, 38, 39, 307, 308, 393 ‘British Health Service and Professional Freedom’  410 British Journal of Social Medicine  117 British Journal of Sociology  161, 165 British Medical Association  79, 193, 197, 278, 390, 546 British Medical Journal  59, 141, 144, 294, 334 British National Conference on Social Welfare  301 Britishness, notion of  103 British Socialism Runs on United States Money  404 British Sociological Association (BSA)  158, 165 Britton, Clare  231, 234, 235, 236, 239, 240 see also Winnicott, Clare Brook, Sir Norman  88, 89, 91 Brookings Institution  296, 428, 495 Brown, Sydney  40, 41 Browne, Megan  333, 334 Bryn Mawr College  411, 425, 427 Bugbee, George  397, 399 Bunbury, Elizabeth  126 ‘Burden of Teaching, The’  324 Bureau of Old Age and Survivors Insurance  383, 407 Bureau of Social Science Research  430 Burns, Clarice  114 Burns, Eveline  350, 373, 374, 382, 390, 394 Butler, Lise  190 Butler, R.A  194

C Cadbury, Laurence J  40, 71, 110 Caine, Sydney  241–​2, 284, 444, 507 Cairncross, Alec  445 Calder, Ritchie  12 California, medical bills in  371–​2 Callaghan, James  474, 475 Cameron, James  468 Cameron Watt, David  532 campaigning bodies  355, 357 Canada  100, 110, 197, 374, 426 canteens, subsidised  59

568

Index Can the Poor Save?  77 cardiac health  145, 148 care, emotional experience of  190 Carmichael, Kay  333, 334 Carnegie Course  227, 232, 236–​41 see also Applied Social Studies Carnegie Trust  119, 231, 235, 237, 242 Carr-​Saunders, Alexander  52, 109, 110, 157–​8, 166, 233 Case Conference  166, 234 Case for Family Allowances  60, 79 casework  230, 234, 340 ‘Casualities of Inequality’  126 Caxton Hall, London  36 Cecil, Lord  36, 38 Central Middlesex Hospital  147 Central Training Council in Child Care  234 Certificate in Mental Health  167 Chamberlain, Neville  64 Chance, C.F  110 ‘Charges for Day Care’  364 charitable organisations  312, 340 charity  95, 96, 278 Charles, J.A.  196 Chernin,Milton  372, 406 Chicago Conference  415–​19 Chicago Tribune  404 Child, the Family and the Young Offender  336 childbirth  134 Child Care course  231, 233, 238, 240, 245 Child Poverty Action Group  355, 356, 361, 442, 552 creation of  281, 441 and family allowances  443, 453 and the SBC  458, 460 children  101, 120, 145, 333 the desire to have  71–​3, 127, 129, 140 homes for  95–​8 playing space  290 and poverty  33, 54, 429 Children Act 1948  96, 290 Children’s Panels  332 Choice in Welfare  485 Christgau, Victor  383 Churchill, Winston  42, 140–​1 Citizens’ Committee for the Children of New York  418 civil defence  88, 100, 104 civil liberties  41, 58, 100 civil rights  404, 411, 413 Civil Service  88, 450–​1 Clapham Report 1946  160

Clark’s Commercial College, London  19, 22 Clause Four  256 Clement Brown, Sybil  230, 234 Cockburn, Christine  362, 363 cohabitation  451, 454–​8 Cohen, Wilbur  244, 370, 405, 427, 433, 498 memorial service  315, 434, 533, 551 Cold War  100, 393, 467 Cole, G.D.H  157 collectivism  47, 546 Collini, Stefan  69, 75, 479, 547, 553 Collinson, Lord  531, 532 Commander of the British Empire  472, 544 Commitment to Welfare  349–​54, 388, 428, 430, 431, 489 Committee Against Malnutrition  59 Committee of Enquiry into Voluntary Workers  336 Committee of Local Authority and Allied Personal Services (Seebohm)  335–​9 Committee on Social Security  56 Common Market  see European Economic Community Common Ownership  42, 43, 46 Commonwealth Immigration Act  277, 470, 472, 473 Common Wealth Party  42, 45 Communist Party  37 community care  289, 291, 302, 426 ‘Community Care and the Mentally Ill’  426 Community Care -​Fact or Fiction ?  291 Community Relations Commission  6, 473, 475–​6 computers, for benefit calculations  461 conscription  63 Conservative Party  38, 128, 461, 528 and costs of NHS  161, 194, 371 and the EEC  477 One Nation Group  257, 259 pension policy  220, 284 view of welfare state  179, 193, 251, 499 consumer goods  33 Consumer’s Guide to the British Social Services  526 contamination  483 Contemporary Poverty, Regional Distribution and Social Consequences  40 contraception  52, 61, 72, 73 Cooper, M.H  494–​5 Cooper, Michael  353

569

RICHARD TITMUSS Corman, Ronald  430, 431 corporate bodies  278 corporate power  266 Cosgrave, Patrick  530 Cosse, Olive  234, 242, 244 Cost of Living and Dying  59 Cost of Living Index  58 Cost of the National Health Service in England and Wales  195 Council for Action for Peace and Reconstruction  36 Council for Training in Social Work  334 Cousins, Frank  473 CPAG  see Child Poverty Action Group Cranbourne, Lord  87 Craske, Bishop Thomas  12 Creech Jones, Arthur  274, 275 Crew, Francis  149 Crick, Bernard  265 Crime and Tragedy  26, 37 Criminal Justice Act 1948  156 Crosland, Anthony  256, 263, 280, 358–​9 Future of Socialism  186, 252 Crossman, Richard  4, 131, 209, 474 and pensions policy  214–​17, 219–​20, 222, 224, 546 and poverty  441, 442, 443, 445, 446 Rhodesia  471 Titmuss memorial service  25, 274, 533–​5 Crossroads in Social Policy  160 Crouch, Colin  514 cultural decline, inter-​war  69 ‘culture of poverty’  413, 415 Culyer, A.J  353, 494–​5, 499 Current Affairs  127 Curtis, Dame Myra  96 Curtis Committee  96, 97, 231 ‘cycle of deprivation’  360, 361 Czech Republic  62–​3

Summer School  462 Department of Health for Scotland  87 Department of Labor  374 Department of Social Administration, LSE, creation of  158 deprivation  358, 361, 413 de Schweinitz, Karl  407, 432, 555 developing countries  300, 321 Dewey, John  162 DHSS  see Department of Health and Social Security (DHSS) diet  64, 134 dignity  344 Diploma in Social Work Studies  245 direct grant schools  360 Disabled Living Foundation  529 discrimination  14 diseases  134, 144, 145, 146, 148 ‘disinherited family’  178 divorce law  355 doctors  126, 190, 294, 301, 311 doctor-​patient relationship  198, 425 from overseas  300, 531 training of  297 see also General Practitioners Doll, Richard  524 Donnison, David  166, 227, 232, 333, 441, 555 Carnegie Course dispute  237–​45 leaves LSE  505 lecture  166 Doron, Abraham  316 Dowell, Rev. Graham  525 Downes, David  514 drugs  189–​90, 425 prescriptions  197–​9 Dunkerton, Ivor  527 duodenal ulcers  146, 344 Durbin, Evan  33, 74 Durham  114 Durkheim, Émile  157

D

E

Dahrendorf, Ralf  158, 227, 512, 514, 515 Daily Mail  337 Daily Mirror  355 Daily Telegraph  491 Danish honours  506 Dartington Hall  312 Darwin, John  132 Day, Professor Alan  513–​14 ‘Declining Birthrate’  134 democracy  42, 138, 261 dental services  196 Department of Health and Social Security (DHSS)  356, 364, 443–​4, 452, 460

East African needs  307, 311 Eckhard, Edith  162 Eckstein, Harry  393, 394 Pressure Group Politics: The Case of the British Medical Association  390 ‘Economic and Financial Problems of the Provision for Old Age’ (Phillips)  208 Economic History Review  91 Economic Research Council  121, 201 economic sanctions  36 Economist, The  218, 254, 281, 333, 554 Edgerton, David  37, 103 Edinburgh University  333, 335, 350 education  180, 201, 341, 349, 360, 511

570

Index comprehensive  278, 279 and inequality  120, 276, 281, 512 pre-​school  95 public schools  261, 278, 279 of troops  127 Education Act 1944  128 Educational Maintenance Allowance (EMA)  356–​60 Education and the Birth Rate  120 ‘Effects of Affluence and Education on Labour Relations’  426 Egypt  319 Eilat, Eliahu  317 elderly  164, 404, 546 see also older people Eleanor Rathbone Memorial Lecture  178–​82 Elliot, Katharine ( Baroness Elliot of Harwood)  232 Emergency Medical Service  89–​90 Emergency Powers (Defence) Act  58 emigration of trained staff  301 employment  12, 45, 205 married women in  175 in Mauritius  309, 310 of older people  206–​8 see also unemployment Encounter  478, 488, 489 Encyclopedia Americana  411 End of Economic Parenthood  72 ‘end of ideology’  279–​80, 408, 412, 497 see also Bell, Daniel English Heritage ‘Blue Plaque’  158 English radicalism  548 environmental factors  112 see also socioeconomic environment epidemiological surveys  343 equality  276, 313, 409 Equality  273, 275 Eshkol, Levi  320 Essays on ‘The Welfare State’  101, 165, 251–​5, 265, 350, 369 ‘Ethics and Economics of Medical Care’  318, 484 ethnic divisions  324 Eton and other public schools  261, 278, 279 Eugene Field Society, Missouri  369 eugenics  24 ‘Eugenics and Poverty’  112 Eugenics Society  46, 51–​3, 56, 64–​5, 80, 168 Eugenics Review  111, 114, 119, 139 hereditarian wing  51, 139 in war  109–​15 European Economic Community  14, 267, 468, 477–​9

evacuation  79–​80, 87, 90–​1, 105, 336 evacuees  97–​9, 110 Evans, Tanya  354 Evening Standard  518 evidence-​based medicine  145 Exley, Sonia  159 expert adviser  60

F Fabian Society  214, 259, 265, 313, 441, 451 ‘Soaking the Poor’  446 ‘fair shares’  102 families  58, 72, 168, 174, 183, 207 deprived  358 family life  93, 140, 143, 183, 184, 279 large  71, 77, 443 one-​parent  354–​6 size of  120, 127, 141, 164, 309 family allowances  79, 121, 127, 178 and birth rate  129, 141 increasing the  442, 453 and liberalism  40, 41 family doctors  378 Family Income Supplement (FIS)  357, 528 family planning  309, 314, 443 family service departments  337 Family Welfare Association  234, 242 Farrer-​Brown, Leslie  158 fascism  34, 37, 514 Fatherless Families Allowance (FFA)  363–​4 Federal Department of Health, Education and Welfare (HEW)  405, 407, 408, 429, 432 Fellow of the Royal Statistical Society  70 Fellowships for Tanganyikans  313 female colleagues  10, 231, 339 Ferguson, Sheila  85 Feversham, Lord  293 Fewer Children: The Population Problem  128 Field, Frank  427, 528, 532, 552 financial crash  33 financial institutions  278, 282 Finer Committee on One Parent Families  349, 354–​6, 358, 363, 549 Fink, Arthur  370 firewatching  86, 104–​5 First World War  1, 22, 23, 35 Firth, Raymond  11 fiscal welfare  180 Fisher, Jack  274 Fitzgerald, Hilde  85, 87 Flanders, Allan  266

571

RICHARD TITMUSS flat-​rate benefits  209 Fleet Street Parliament  26, 34–​7, 129 Fletcher, Raymond  282 Florida Presbyterian College  427 Food, Health and Income  55 foodbanks  556 Forder, Anthony  339 Ford Foundation  424, 494, 525 foreign policy in the 1930s  34, 35–​9 Forward March  42–​5 Francis-​Williams, Lord  266 Franklin, Norman  165 Freeden, Michael  41, 46, 53, 75, 547 freedom, individual  3, 76, 186 Freeman, Hugh  298 free-​market  3, 257, 499, 544 free trade  39 Freud, Sigmund  162 Friedlander, Walter  406, 407 Friedman, Milton  416 Friendly Societies  389 front-​line staff  449–​51 Fulham Fellowship for the Unemployed  28 Furth, Charles  350, 397, 495–​6 Future Medical and Social Needs  298 Future of Socialism  186

G Gaitskell, Hugh  178, 220, 255, 256, 260, 275 Galbraith, John  254, 369 Affluent Society  255, 260 Galdston, Iago  490–​1 Gales, Kathleen  301 Galton, Francis  114, 117 gang violence  279 Gardening for the Disabled  529 gastric ulcer  146 Gaus, John  254 gender issues  10, 30, 131, 185, 246 General Practitioners  197, 297, 302 field research of  148–​50 and prescriptions  197 role of  293, 337, 377–​9 General Register Office  148 genes, inherited  53 Genesis of the Health Service  485 George Allen and Unwin  350, 365, 392, 397 German population statistics  61–​2, 87, 111, 133 Gift, The  497 Gift Relationship  14, 431–​2, 483, 494–​500, 527 research for  489–​93 Gilbert, Bentley B  389–​90

Gingerbread  356 girls and education  360 Glasgow  116, 117, 144 Glass, D.V  52, 110, 119, 156–​9, 165 Glass, Ruth  190 Glennerster, Howard  21, 361, 427, 428, 554 Glittering Coffin, The  263 Glover, James Alison  90 Goldberg, Tina  343 Goldman, Laurence  267, 273 Gollin, Albert  430 Goodenough Report 1944  297, 302 Gough, Ian  496 government, the role of  92–​4 Gowing, Margaret  19, 20, 23, 25, 29, 85, 505, 524 GP  see General Practitioners Grant-​Duff, Ursula  41, 62 Great Depression  33 Greece’s military junta  512 Griffiths, James  165 Grimley, Mathew  512 Grundy, Fred  87, 159 Guardian, The  260, 442, 459, 489, 527 Irresponsible Society  262 Guillebaud Committee and Report  6, 13, 193–​7, 197–​9, 376, 390 Guy’s Hospital  295

H Habakkuk, H.J  104 Haberdashers’ Aske’s school  9, 280 Hadley Roger  514 Hailsham, Lord  261 Hall, Lesley  53 Halsey, A.H  8, 74, 449, 489, 543, 551 Hamilton, Lady Pat Gardening for the Disabled  529 Hammond, R.J  160 Hancock, Keith  40, 89, 104, 155, 159, 531 Handbooks for Discussion Groups  126 Harper’s Magazine  392, 484, 485 Harrington, Michael  413, 428, 429 The Other America  406 Harris, Bernard  102 Harris, Jose  86, 102, 176, 388, 397, 555 Harris, Ralph  257, 486–​8 Harrison, Brian  52 Harrod, Roy  40 Hart, D’Arcy  147 Hart, Judith  332–​3, 355, 444, 475, 535 Hartshorn, Alma  232 Harvard University  254, 387–​9, 390, 396, 554

572

Index Harvey, Audrey  454 Hastings, Somerville  144 Hatton Garden  105 Hayek, Friedrich  494 Haynes,G.E  100, 101 Hayward, Richard  444, 450 health  92, 189, 207, 229 of army recruits  40, 63–​5 inequalities  51, 58, 64, 164 manual workers  150 healthcare  35, 45, 424 market’s role in  483 for US poor  404 Health Information Foundation (HIF)  397 Health in Middle Age  148 health insurance in Tanganyika  314 Hebrew University  316, 317, 320 Heclo, Hugh  213–​14, 363, 387–​9 Modern Social Politics in Britain and Sweden  388 Henderson, J.M  34, 70 Hendon Liberal Association  34 Hendry, Charles  374, 375 Hepworth, Barbara  469 Herbison, Peggy  200, 444 Hetherington, Sir Hector  232 Hickey, Margaret  416 higher education, diversity in  511 Himmelweit, Professor Hilde  513 Hinden, Elchon  213 Hinton, James  98 Hiscock, Ira  391 Historical Association  130 History of Occupational Pensions in Britain  282 History of the Second World War  85 Hitler  39, 61, 72, 133 Hitler’s Man-​Power Problem  61 Hobsbawm, Eric  507 Hodges, M.W  296 Hogben, Lancelot  117–​18 Hoggart, Richard  178, 547–​8, 549 Home Front, history of  91–​4, 101, 105, 543 Homes in Canada Service Committee  110 Honigsbaum, Frank  398–​9 Hopkins, W.A.B  195 Horder, Lord  40, 52, 110, 114, 159, 164, 168 Hospital and its Patients  190 Hospital and Social Service Journal  337 Hospital Plan for England and Wales 1962  291 hospitals  92, 190, 291, 311 and local authorities  192

in London  302 psychiatric  290 in Tanganyika  314 Houblon-​Norman Fund  282, 284 Hough, Matthew  5 Houghton, Douglas  336, 338 housing  120, 145, 341 Howard, Donald  410, 426, 429, 431 Howe, Geoffrey  3, 339, 462, 472 Hubback, Eva  52, 60, 86, 109, 119, 126 Huddleston, Rev. Trevor  532 human behaivour  33 humanism  265 human psychology, misunderstanding  552 Hungary  467 Hunter, David  424 Hurstfield, Miss R  87 Hurtwood, Lady  290 Huws Jones, Robin  317, 336, 338 Huxley, Julian  111, 265, 467

I IEA  see Institute of Economic Affairs Ikhimokpa, M.I  531 illegitimate births  355 immigration  324, 353, 470, 473 impact of  413, 418 in Israel  322–​3 Income Distribution and Social Change: A Study in Criticism  280, 281, 284, 430, 485 income maintenance  356–​9, 394 income tax  320 Israel  319 see also taxation independent self-​reliance  257 India’s population  131–​2, 145 Individual and Social Importance of Activities for the Elderly  221 individual choice and freedom  8, 266, 293, 389, 546, 547 individualism and collectivism  76, 257, 416, 547 individual responsibility  3, 541 individual rights  546 Industrial Change and the Employment of Married Women  375 Industrialization and the Family  252 industrial revolution, the second  183 Industrial Society and Social Welfare  229 industries, new  33 inequality  278, 281, 349, 418, 556 growing  266, 414 in health  164, 296 recognising  412, 413, 419

573

RICHARD TITMUSS Infant and Maternal Mortality in Relation to Size of Family and Rapidity of Breeding  114 infant mortality  40, 45, 54, 59, 78, 143 and maternal incompetence  79 during war  94 see also population inflation  205 Ingleby Committee  332 inherited poverty  415 Innovator, The  435 Institue of Education  232 Institute of Directors  264 Institute of Economic Affairs  256, 257, 353, 393 and the Gift Relationship  483, 484–​8, 494, 495, 499–​500 Long Debate on Poverty, The  526 and Milton Friedman  416 Institute of Industrial Relations  406 institutional care  290 insurance companies and pensions  24, 210, 255, 259, 260, 262 integrated local services  341 integrated social rights  418 integration of social work  336 International Association of Gerontology  206–​7 International Centre  467 International Conference of Social Work  182–​4 International Peace Conference, Geneva  26 International Social Security Association  362, 363 inter-​war cultural decline  69 ‘Introduction to Social Case Work’  230 Irresponsible Society  24, 251, 255–​8, 265, 290 influence of  266–​8 privilege in society  278, 279 reaction to  259–​62 Israel  13, 307, 317–​21 ISSA  see International Social Security Association Isserlis, A.J  6

Jerusalem Seminar  320–​5 Jewish people  325, 507, 514 see also Israel Jewkes, John and Sylvia  485 Jobson, Richard  264 John Hopkins University  425 Johnson, Kenneth  374, 381, 382 Johnson, Paul  469 Johnston, J.O  333, 335 Joicey, Nicholas  59 Jones, Dr Alice Mahony  78 Jones, Harriet  194 Jones, Kathleen  232 Joseph, Sir Keith  258, 361, 444, 450, 500, 528 Joseph Rowntree Trust  492, 494 Joules, Horace  190 Journal of Social Policy  11 Judd, Frank  473–​4 juvenile delinquency  279, 332 juvenile rheumatism  144, 145, 146

J

L

Jackson, Ben  252, 257, 268, 273 Jameson, Sir William  229 James Seth Lecture  176–​8 Jarvis, Fred  279 Jay, Douglas  164, 479 Jefferys, Margot  295, 350–​1, 353 Jeger, Lena  274, 462 Jenkins, Roy  164 Jerusalem Post  318, 320

Labour, Life and Poverty  150 Labour Party  1, 3, 126, 146, 552 1945 election  42, 127, 190 and education  278, 279, 518 and the EEC  477 modernisation  186, 256, 276, 280 NHS Working Party  199–​202, 289 pension policy  13, 205, 213–​15, 215–​20

K Kahan, Barbara  355 Kahn, Alfred  418, 424 Kahn, Hilda  317 Kaiser, Philip  469 Kaldor, Nicholas  445 Kanev, Itzhak  316, 317, 318, 319 Kansas Blood Bank Case  490, 492 Katz, Israel  317, 320, 323, 325, 474 Katz, Miriam  317, 320, 325 Keele University  485 Kemp, Arthur  485 Kennedy, Senator Edward  432 Kenyan Asians  473, 474 Keppel Club  295, 311, 312 Keynes, John Maynard  2, 57 Kidd, Harry  240, 515–​16 Kidd, Ronald  41 Kilbrandon Committee  332 King, Martin Luther  405 King George V  53, 140 Kuczynski, Robert René  52, 62, 117, 119 Kydd, Janet  234, 235, 239 Kynaston, David  546–​7

574

Index and poverty  357, 441–​3 Signposts for the Sixties  266 Titmuss, opinion of the  35, 46 Lafitte, François  43, 58, 138, 155, 295, 499 laissez-​faire  494, 548 Lamont, Geoffrey  462 Lancet, The  87, 146, 293, 497, 500, 554 Land, Hilary  510 Lansky, Melvin  488, 489 Lash, Trude  418 Laski, Harold  408 LCC  see London County Council League for Industrial Democracy  266 League of Nations  35, 36, 38, 39, 309 Lebaux, C.N  229 lecturing  129–​30, 141–​2, 184–​6 Fawcett lecture  173–​6 Rathbone lecture  178–​82 Seth lecture  176–​8 social work  182–​4 Lees, D.S  485 Left Book Club  125 Left News  126 Left Review Club  254 left-​wing, American  280 ‘Legacy of Richard Titmuss’  435 legal dispute  486–​8 Le Grand, Julian  495 Le Gros Clark, Frederick  59, 60, 207, 211, 221 Lester, Anthony  451–​2, 471, 510 ‘Let the People Decide’  479 Leverhulme Trust  24, 70, 116, 159 Levy, Dr W  293 Lewis, Aubrey  116 Lewis, Jane  144, 239, 242, 355 Leybourne and White  120 Liberal Party  1, 33–​5, 121, 162, 546 Summer School  40–​1, 46, 70, 408 and Titmuss  26, 29, 45–​7, 47, 126, 542 ‘Life After Sixty’  206 life expectancy  205, 212, 298 Limits of the Welfare State  5 Lindsay, Kenneth  321, 322 Lindsey, Almont  391, 392, 393, 394 Lipsey, Richard  517 Listener, The  266 listening role, of the doctor  344 Lister Institute of Preventive Medicine  493 literary agent  41, 70, 125 Living Space and Population Problems  62 living standards  256 Lloyd George, David  36, 71, 80, 221 ‘Call to Arms’  36

Lloyd Roberts Lecture  141–​2, 159 local authorities  289, 331, 335–​9 and mental health care  290, 292 Local Authority Social Services Act 1970  342 Loch Memorial Lecture  394 Loeb, Robert E  425 Logan, Douglas  157 London County Council  35, 119, 148, 174 London hospitals  302 London School of Economics and Political Science  1, 3, 9, 166–​7 student disruption  10, 14, 119, 508–​10, 512–​14 Titmuss’s appointment and role  13, 53, 148, 155–​60, 273, 283 London School of Hygiene and Tropical Medicine  295, 311 London’s East End, family life in  215 London’s homeless  98 Long, Vicky  290, 292 Lowe, David  242 Lowe, Rodney  256 Low-​Pay Unit  552 LSE  see London School of Economics and Political Science LSHTM  see London School of Hygiene and Tropical Medicine Lukoff, Irving  395 Luton Town Council  21, 87, 159 Lynes, Tony  8, 277, 280, 282, 284, 442 and Mauritius  307, 308

M MacCarthy, Helen  150, 175–​6 Macdonald, Dwight  406 Macdonald, Professor George  311 MacKenzie, Norman  253 Mackintosh, Professor  87 Macleod, Iain  179, 193–​4, 196, 223, 228, 257 MacNalty, Sir Arthur  140 Macnicol, John  205 MacRae, Donald  9, 353 Makere University College, Uganda  307 malnourishment and malnutrition  55, 59, 63, 64, 145, 339 Manchester Guardian  91, 99 Manchester University  396 Manifesto for the Common Man  47 Mann, Kirk  553 Mannheim, Karl  162 manual workers  150, 277 Marchant, Sir James  140 Marcus, Dr Abraham  318, 484

575

RICHARD TITMUSS market approaches to the NHS  556 Marks, Abraham J.  325 Marquand, David  443 Marquand, Hilary  214, 216, 219, 273, 544 marriage  175 Marshall, T.H  2, 99, 101, 103, 119, 351, 532 review by  99 Titmuss obituary  156 Martin, John  197, 198 Martin, Kingsley  4, 45, 60, 72 Martin Lipset, Seymour  412 Martin Luther King Foundation  476 Marwick, Arthur  71 Marxism  138, 512 Massachusetts Institute of Technology  373 Maswanya, Saidi  312 materialism  77 maternity  59, 79, 120, 121, 314 mature students  230 Maud, John  91 Mauritius  13, 307, 308–​11, 544 Mauss, Marcel Gift, The  497 Maycock, Dr  493, 494 McCarthy, Senator John  236 McDougall, Kay  166, 230–​1, 234–​6, 239, 240–​4, 246 McGill University  426 McGregor, O.R  355 McKenzie, Norman  555 McKibbin, Ross  24, 27, 30, 103 McRae, Donald  351–​2 Meacher, Michael  359, 499 Meade, James  3, 308, 309 means-​testing  194, 448, 463–​4, 550 Family Income Supplement (FIS)  528 opposition to  92, 357 media  125, 155, 468, 544 medical administrators, training of  294 medical bills in America  371–​2 Medical Care  312, 393, 484, 486–​7 Medical Care Act 1966 (Canada)  197 medical education  200, 202, 289, 314, 343, 377 medical schools  296, 299 need for  290–​3 Royal Commission  294–​8 medical ethics  425 Medical Ethics and Social Change  310, 311 Medical Officer  140 Medical Officer of Health (MOH)  87, 331, 334, 336–​8, 343 medical profession, criticism of  253 Medical Research Council  90, 147–​8, 155, 157, 159, 344

medical science  189, 191, 205 medical services, organisation of  311 Medical Society at University College Hospital  59 Medical Survey Committee  311, 313 Medicare and Medicaid Act 1965  404–​5 Medley, J.C  496 Medlicott, W.N  104 Meinhardt, Marie  87, 531 Mellanby, Edward  147, 148 Members One of Another  199–​202, 548 men, degradation of  183 Mencher, Sam  396 Poor Law to Poverty program: Economic Security in Britain and the United States  394 Private Practice in Britain: The Relationship of Private Medical Care to the National Health Service  395 mental health  13, 92, 164, 167, 200, 341 and community care  289 and environment  189 and medical education  302 services  426 Mental Health Act 1959  290 Mental Health course  231, 233, 238, 244, 291 Mental Health is Everybody’s Business  291 Men Without Work  58 Merriam, Ida  350, 363, 405, 407, 423, 428, 433 Merton, Robert  6, 162 message  see audience, reaching an middle classes  24, 30, 202, 253, 409 and prescription charges  198 protesters of the  549–​50 tax benefits  556 and the WVS  97–​8 Middleton, Stuart  256, 263 Midgley, James  310 Midwinter, Kay  221–​2 midwives, recruitment and training of  121 Miliband, Ralph  3, 468 military recruits, health of  101 Military Training Act (1939)  63 milk, state-​subsidised  59 Miller, Kathleen (Kay)  see Titmuss, Kay Miller, Mike  416, 417, 424, 428, 489, 494 ‘Legacy of Richard Titmuss’  435 Millicent Fawcett Lecture  173–​6 Minister of Health, Tanganyika  312 Ministry of Finance, Israel  319 Ministry of Health  87, 114, 121

576

Index Ministry of Overseas Development  315 Ministry of Social Welfare  317 modern life  150, 183–​5 Modern Social Politics in Britain and Sweden  363, 388 MOH  see Medical Officer of Health (MOH) Monckton, Harold  206 Monopoly of Choice in Health Services?  487 Moorhouse, Geoffrey  442 moral basis of social policy  91, 388, 395, 419, 498, 499 moral values  42, 70, 137, 164, 261, 357 Morgan, John  100, 375 Morgan, Kenneth  276 Morris, Galia  145, 146 Morris, Jerry  126, 145, 193, 343, 524, 532 juvenile rheumatism  144 social medicine  134, 137, 143 on Titmuss  553, 555 Morrison, Herbert  35, 116, 119 mortality, regional  54 see also population Moser, Claus  11 Mosley, Oswald  34, 514 Mowat, C.L  102 Moynihan Report  415 MRC  see Medical Research Council Murphy, Shaun  147 Myrdal, Alva  52 Myrdal, Gunnar  111, 165

N NAB  see National Assistance Board NAMH  see National Association for Mental Health Nasser, President  319 National Assistance Board  443, 446, 454 National Association for Mental Health  290, 291, 292, 293, 532 National Association of Authors and Journalists  369 National Birthday Trust Fund  121 National Blood Transfusion Service  484 National Broadcasting Company  392 National Conference on Social Welfare  415–​19 National Coucil for One Parent Families (NCOPF)  355 National Council for Civil Liberties (NCCL)  41 National Council for One Parent Families (NCOPF)  356 National Council of Civil Liberties  100

National Government  33, 35–​9, 55 National Health Service  1, 141, 147, 148, 534, 543 American lectures  376, 410 costs of  6, 194–​8, 371 early years  189–​96 employment opportunities  160 LP Working Party  199–​202 market approaches to  556 overseas staff  300, 301 shortcomings  189 see also Guillebaud Committee National Health Service in Britain  192 National Institute for Social Work Training  317, 336 National Institute of Social and Economic Research (NIESR)  194 national insurance, Israel  320 National Insurance Act 1911  197, 389 National Insurance Act 1959  222, 260 National Insurance Fund  209 nationalisation  35, 47 National Old People’s Welfare Council  267 National Peace Council  37 National Superannuation  218 National Union of Societies for Equal Citizenship  52 National Union of Teachers  279 Nature  117 nature and nurture  53, 112, 118 Nazism  37, 61, 113, 150 in Germany  35, 36, 102, 343 neo-​natal deaths  148 Newfield, Maurice  109, 115, 116, 139 New Left Review  3 News Chronicle  41, 219 New Society  266, 339, 448 newspaper articles  5 New Statesman  4, 45, 72, 446, 489, 499 New York Academy of Medicine  491 New York City, blood donation in  490 see also Gift Relationship New Yorker, The  406 New York Times  428, 429, 431, 500 New Zealand  142, 168 NHS  see National Health Service Niemeyer, Sir Otto  157, 291 Nigeria  531 non-​judgemental care  228 non-​medical staffing  290 Notting Hill riots  470 Nuffield Foundation  119, 148, 284, 428, 493 Nuffield Provincial Hospitals Trust  301 nursery schools  95, 97, 290 nurses  200

577

RICHARD TITMUSS Nursing Mirror  460 nutrition  59, 79, 80 Nutt, Harry  274 Nyere, Julius  313, 314, 315

Oxford Political Circle  253 Oxford University  449

P

O Oakeshott, Michael  9, 510 Oakley (née Titmuss), Ann  7, 62, 145, 236, 532 Carnegie Course dispute  227 and cohabitation issue  456 education  9, 280 on father at LSE  156, 162 on father’s early life  20, 21, 22, 23 on father’s political stance  472 on mother  25, 28, 29, 362 on parents’ marriage  10, 27, 30, 523, 545 on Peter Townsend  518, 519 reception of Parents Revolt  140 travel with parents  317, 323, 375, 382 Oakley, Robin  497 O’Brian, Sally  532 O’Brien, P.K  253 Observer, The  19, 478, 510 ‘Apostle of Equality’  275 ‘Welfare Professor’  255 Occasional Papers in Social Administration  166 occupational pensions  185, 526 cost of  181, 409 hostility to  215, 217 and inequality  273, 282–​4 occupational welfare  181 O’Connor, Alice  414 offenders, young  332 Offer, John  75 older people  205, 206–​8, 267, 425 One Nation Group  257, 259 one-​parent families  354–​6 international comparisons  362–​3 see also Finer Committee on One Parent Families Ontario  426 Open University  11 opthalmic services  196 Ordeal by Planning  485 Orwell, George  131, 547, 549 Other America, The  413 Ottawa Conference  39 Our Food Problem: A Study of National Security  59 overpopulation  133 overseas development  315 overseas doctors  295 Owen, David  499 Oxford Dictionary of National Biography  20

paperbacks  59 Parents Revolt: A Study in the Declining Birth-​Rate in Acquisitive Societies  128, 137–​40 patent medicines  147 patients  190, 191, 192, 377 patterns of behaviour  357 Paul Baerwald School of Social Work  317, 318, 323 peace  12, 26, 34, 36, 37, 427 ‘Peace Ballot’  35 Peace News  514 Pearson, Karl  24 Penguin Books  42, 59, 60, 69 pensions and pensions policy  3, 13, 165, 193, 205, 254 developing policies  208–​11 and the Labour Party  213–​15, 216–​20 PEP  see Political and Economic Planning peptic ulcer  146, 147 Percy Commission  290 Perkins, Dudley  193 Personal Aggressiveness and War  33 personality, injury to  185 Personnel Management  167 pharmaceuticals  425 Phillips, Morgan  217 Phillips Committee  208–​9, 210, 211, 212 Philosophy of Welfare  435 philosopy of welfare  173, 436, 551 Physical Training and Recreation Act  55 Piachaud, David  4, 314, 528, 555 PIC  see Population Investigation Committee Pickering, Sir George  425 Pike, John  527 Pilkington Committee  376 Pinker, Robert  158, 255, 342, 398, 477 Social Theory and Social Policy  552–​3 Pitman Medical  486–​7 Planning  56 planning, models of  71 Planning and the Birth Rate  70 playing space for children  290 Plowman, Garth  11, 524, 525 polarisation of society  357 Polish Jews  507 Political and Economic Planning  56, 57, 71, 119, 190 Political Quarterly  212, 526

578

Index Pollard, B.E  87 poor, the  34, 45, 253, 358, 453 in America  429 and education  279 infants of  116 and rationing  77 Poor and the Poorest  358, 442 Poor Law  184, 211, 212, 316 Poor Law to Poverty program: Economic Security in Britain and the United States  394 Popular Fronts  37, 126 population  1, 23, 133, 142 in Asia  138 decline  41, 51, 54, 71, 128, 140 health  12, 51, 56, 57–​60, 109, 143 in Mauritius  309 Population (Statistics) Act 1938  111 Population Index  61 Population Investigation Committee  109, 118–​22, 134, 139, 159, 168 Population Policy and Family Allowances  40 Population Studies  119 Position of Women, The  131, 252 Postan, Michael  86, 88, 91, 275 post-​war ‘baby boom’  119 post-​war consensus and reconstruction  1, 70, 92, 102, 125, 144, 354 Potter, Dennis Glittering Coffin, The  263 poverty  5, 20, 150, 266, 416, 556 in America  406, 411, 429 and children  33, 145, 358 and infant mortality  40, 79 and older people  205, 207 ‘poverty lobby’  19, 357, 413–​17, 441–​3, 528 regional  54 and socioeconomic change  256, 257, 260, 281, 412, 443 Poverty and Population: A Factual Study of Contemporary Waste  1, 40, 51–​60, 143, 144, 159 Poverty in Britain  443 Powell, Enoch  179, 293, 410, 488 immigration  475, 479 means-​testing  193–​4, 257 psychiatric hospitals  290–​1 power  262, 349, 542 Powicke, F.M  90 Poynter, F.N.L  490 Pratt, Cranford  313 pregnant and nursing women  59 pre-​school education provision  95 prescription charges  197

President Johnson  403, 410, 416, 435, 468 ‘War on Poverty’  280, 370, 389, 391 President Kennedy  383, 403, 405, 406, 429 President Nixon  383, 410, 428, 432, 433 President Roosevelt  71, 133, 370 Pressure Group Politics: The Case of the British Medical Association  390 preventive medicine  126 preventive mental health service  290 Priestley, J.B  42 Princess Margrethe  506 prison reform  156 private pensions  210 Private Practice in Britain: The Relationship of Private Medical Care to the National Health Service  395 privilege  279 problem families  168, 361 Problems in the Aid to Dependent Children Program  383 ‘Problems of Health and Welfare in East Africa’  426 Problems of Population  126 Problems of Social Policy  1, 2, 101–​4, 189, 534, 555 and American scholars  143, 369, 388, 390 description and criticism  89–​94 publication and reception  99–​101, 155, 542 and wartime  72, 80 working on  45, 85–​8 professional classes  163–​4, 277–​8, 299, 337, 376 professional freedom  377, 393, 407 professional models  311, 313 professional power  161, 191, 390 ‘professional self ’  229 Proops, Majorie  355 ‘Prophet of Equality’  273 psychiatric hospitals  290 psychology  and modern society  33, 183–​5, 230 in social work  299 Public Administration  390 Public Assistance Committee  96 public health  331, 343 public life, sincerity in  44 public schools  278, 279 public-​sector pensions  209 public services  260 public-​speaking  129, 155 Purdue University  370 puritanical approach  186, 352

579

RICHARD TITMUSS

R race relations  6, 11, 13, 267, 404–​5 Race Relations Act 1965  471, 473 racial discrimination  10, 277, 307, 470–​2 radio and television  5, 125, 131–​4, 407, 543 see also BBC Raison, Timothy  339 RAMC  see Royal Army Medical Corps Ramsay, Michael, Archbishop of Canterbury  472 Rapoport, Lydia  372 Rathbone, Eleanor  60, 71, 79, 80, 127 Rawl, John Theory of Justice  528–​9 Reading, Lady  97, 98, 99 Red Cross Blood Program, The  498–​9 Reddin, Mike  411, 427, 493, 494 Redgrave, Vanessa  468 refugees  41, 52, 62, 150, 406, 514 internment of  58 regional health disparities  51, 54 Rein, Martin  313, 425 Reisman, David  7–​8 Relative Deprivation and Social Justice  476 Religion and the Rise of Capitalism  275 Relm Foundation  494 Renwick, Chris  119 Responsible Society  257 retirement  206, 209, 222 see also pensions policy rheumatic heart disease  146 Rhodesia  469, 471, 509 Rhys Williams, Lady  121, 201 Richardson, Elliot  432 Richard Titmuss Lecture  317 Richman, Harold  427 Riessman, Frank  428 rights, legally based  462 riots  415, 470, 475 Robbins, Lord  279, 532 Robbins Report  279, 518 Roberts, Ben  510 Roberts, Helen  236, 239 Robinson, Kenneth  291, 293 Rodgers, Bill  259, 260 Rogan, Tom  69 Roman Catholic Church  95, 310 Roosevelt, Eleanor  418 Rose, Hilary  254, 532 Rosen, George  100, 143, 369 Ross, William  332 Rostow, Eugene  373, 424 Rostow, W.W  280, 373 Royal Army Medical Corps  45, 56, 109, 119, 145

Royal College of Obstetricians and Gynaecologists  121, 134 Royal Commission on Doctors’ and Dentists’ Remuneration (the Pilkington Committee)  376, 485 Royal Commission on Medical Education (Todd)  11, 13, 147, 201, 294–​8, 301, 343 Royal Commission on Mental Health (Percy)  290 Royal Commission on Population  118–​22 Royal Commonwealth Society  544 Royal Navy Current affairs  130 Royal Society of Health  336, 340 Royal Statistical Society  24, 133, 339 Runciman, W.G. Relative Deprivation and Social Justice  476 Russell, Bertrand  467 Russell, Kit  231 Ryle, John  144, 146

S Samuel, Lord  34, 41 Sandal, Michael  554 Sanders, Marion  485 Savage, Mike  150, 160, 165, 517 Scandinavia, study of  362–​3 Schilling, Richard  147 school meals  93, 102, 142 School of Social Welfare, California  372 School of Social Work, Columbia  373 School of Social Work, Israel  317, 325 School of Social Work, Toronto  374 School of Welfare  406 Schorr, Alvin  6, 404, 428, 429, 430, 525 Problems in the Aid to Dependent Children Program  383 Schottland, Charles  182, 374, 408 Schriffin, Andre  432 Scotland  59, 87, 90, 121 Scottish Council of Social Service  232 Scottish social work  331–​5 Second World War  109, 113, 132, 133 aerial bombing  44, 89–​90, 92, 99, 104, 105 coalition government  42 history of the Home Front  91–​4 rationing  77–​8, 80–​1, 160 social policy  7, 85, 89 and the welfare state  103 see also evacuation Seebohm Committee  13, 331, 334, 335–​9, 429 Seebohm Rowntree, B Waste of Life  55

580

Index Seldon, Arthur  3, 257, 266, 494, 500, 551 attacks on Titmuss  463, 484, 486–​9 review of Commitment to Welfare  353–​4 Seldon, Majorie  491–​2 self-​consciousness  228 selfishness  77, 129 Seth, James  176 sexual attitudes  355 Sheard, Sally  195, 339, 532 Sherrill Foundation Lectures  375, 424 Shore, Peter  11, 279, 358, 468, 518, 530 Simey, Tom  55, 282, 316 Siminoski, Dan  394 Simon, Sir John  77 Sinfield, Adrian  426, 472, 544, 554–​5 Singer, H.W  57, 58 single mothers  363–​6, 454–​8 Six Point Group  130 Sladden, G.C.F  360 Sloman, Albert  517, 519 SMA  see Socialist Medical Association Smith, Adam, Wealth of Nations  213 Smith-​Mundt Fellowship  233, 234 ‘Soaking the Poor’  446 Social Administration  2, 156, 160–​6, 283 Social Administration Association (later, Social Policy Administration)  11 ‘Social and Psychological Factors in the Aetiology of Disease’  300 social class  51, 246, 276, 300, 324, 411 and infant mortality  117 and morality  163 social conscience  156 ‘Social Credit’  43 social dislocation  5 Social Division of Welfare: Some Reflections on the Search for Equity  10, 178, 209, 252, 253, 430, 553, 556 ‘Social Environment and Eugenics’  114 social environment and the family  141 ‘Social Factors Related to Medicine’  300 social history of medicine  100 social inequality  5, 30, 145, 181 social insurance  310, 389 socialised medicine  376, 424, 486 socialism  20, 45, 52, 74–​5, 313, 404, 546 ‘Socialism in the Sixties’  259 Socialist Medical Association  126, 144, 199, 296, 393 ‘Socialists’ Programme’  35 Socialized Medicine in England and Wales  391

social justice and government  92 social medicine  112, 126, 137, 143–​6, 147 Social Medicine Research Unit  137, 147–​50 social needs  252 ‘Social Needs and Costs: An Essay in Confusion’  165 social policy  2, 159, 165–​7, 174, 175 in America  381–​4 and Conservative government  257–​63 and the Labour Party  441–​4 see also Problems of Social Policy; Social Policy: An Introduction Social Policy and Administration  353 ‘Social Policy and Economic Progress’  416 ‘Social Policy and the Responsible Society’  259 Social Policy: An Introduction  388, 423, 506, 528 Social Politics and Population Growth in Mauritius  309 social reconstruction  42, 48, 131 social reform in America  403–​5 social rights  461 Social Science and Administration  230 Social Science Certificate  167 Social Science Research Council  11 social security  3, 56 in Mauritius  309 Social Security Act 1935 (US)  404 Social Security Act 1966  443 Social Security Commissioner  383 social services  163, 192, 258 and the Conservative Party  258 in Israel  320 Social Services  176–​7 social solidarity  113, 144, 543, 549 social values  260 social welfare  178–​82 social work  13, 173, 182–​4, 227 Social Work (Scotland) Act 1968  332 ‘Social Worker in a Social Welfare State’  380 social workers  149, 289, 382 number of  337, 338, 342 report on  237 training of  182, 227–​30, 231–​9, 323, 336, 343–​5 Society of Social Medicine  296, 299 socioeconomic environment  53, 112, 145, 146, 230, 415 and health  189 socioeconomic inequality  277 socioeconomic power  259 Sociological and Ethnic Aspects of Therapeutics  425

581

RICHARD TITMUSS sociological concepts  300, 351 Sociological Review  70 sociology  156–​7, 160, 165, 281, 299, 512 Soloway, Richard  53 Somerville College  9 South Africa, apartheid in  10 Soviet Union  71, 72, 100, 113, 138, 467 Spanish Civil War  36 specialist courses  233, 238 specialists  379 Spectator, The  61, 64, 252, 263, 264, 487 ‘Can the Poor Save?’  77 ‘Care or Cant’  291 Spencer, John  350 Stalingrad  133 standard of living  216 Standard Telephones  22 Stark Murray, David  199, 393 state pension  205 Stationery Office  88, 90 statistical data  57–​61, 121, 134, 196, 280, 397 Statistics of Parenthood  140 St Bride’s Institute, Fleet Street  35 Stephen Aske  34 sterilisation  119 Stevens, Rosemary  296, 312, 495, 496 Stevenson, Adlai  388 Stevenson, Olive  354, 449, 456 stigmatisation  412, 444, 445 stillbirths  148 Stirling Ross, James, National Health Service in Britain  192 Stocks, Mary  121 St Paul’s Church  104–​5 stress of modern life  146, 164, 175, 177, 228 St Thomas’s Medical School  295 students  230, 359, 455, 511 female  174, 231 overseas  295, 307 student unrest at LSE  508–​10, 512–​14 Study of Social Medicine  146 Suffolk Children’s Department  242 Summerskill, Edith  130, 165, 455 Sunday Times, ‘Under Labour, the Poor Get Poorer’  453 superannuation  210, 215–​20 Supplementary Benefits Commission  11, 353, 441, 443–​6, 524 staff training  448–​51 supplementary benefits for single parents  365

Supplementary Benefits Handbook  445, 454, 463 surgical techniques  189 Sutherland, Graham  469 Swain, Michael  335 Sweden  103, 142, 211–​12, 363 Syracuse University  411

T Tanganyika  13, 307, 311–​15 Tawney, R.H  46, 74–​7, 93, 128, 137, 555 Acquisitive Society  275 celebrating Tawney  273–​7 Equality  273 Religion and the Rise of Capitalism  275 research on  396–​7 taxation  180, 181, 185, 210, 281 Taylor, Stephen  146 teaching standards  511, 515 technological change  414 Terkel, Studs  419 Terrill, Ross  285, 396–​7 thalidomide  5, 425 Thane, Pat  119, 192, 207, 354, 388, 544 Thatcher, Margaret  4, 339, 436, 485 The Nation  414 Theory of Justice  528–​9 Time and Tide  130, 469 Times, The  36, 117, 140, 161, 361, 453 ‘Age of Pensions’  209, 212, 218 on the EEC  479 on health of troops  64 letter to  95, 191, 198, 290, 508 obituary  432 ‘An Outstanding Social Administrator’  530 review of Problems of Social Policy  155 Times Literary Supplement  352 Titmuss, Kay  1, 35, 134, 145 Fulham Fellowship for the Unemployed  28, 53 married life  10, 20, 25, 26, 29 Parents Revolt: A Study in the Declining Birth-​Rate in Acquisitive Societies  137–​8 Philosophy of Welfare  435 remembering Richard  433, 530, 531, 532, 535 Richard’s death and funeral  310, 523, 526 Social Policy: An Introduction  423 travel with Richard  314, 317, 320, 375, 382 Titmuss, Richard, personal life  childhood  19–​23

582

Index early political activities  24, 27, 33–​7 employment  12, 21, 105, 145, 157 firewatching  104–​5 friends and leisure  86, 145, 274, 325, 396, 428 ill-​health, cancer and final illness  199–​200, 222, 283, 316, 523–​6 marriage and family  25–​30, 426, 429, 524, 545 memorial service and obituaries  423, 431, 531–​4 see also Oakley, Ann; Titmuss, Kay Titmuss-​Meinhardt Fund  535 Titmuss paradigm  4–​7, 103, 552 Todd Commission  294–​8 Tonight  281 Too Few Babies  132, 140 Towle, Charlotte  232, 234, 235, 236, 239, 244 Town and Country Planning  120 Town and Country Planning Association  70, 74 Townsend, Peter  166, 178, 355, 400, 532, 555 ‘Inequality and the Health Service’  531 Irresponsible Society  257, 258–​63 Keppel Club  295 and pensions policy  209, 214–​17, 218–​21, 388 Poor and the Poorest, The  442 and poverty  266, 441, 443, 453, 528 relationship with Titmuss  454, 472, 516–​18, 544–​5 review by  252–​3 and the SBC  458–​60 Trades Union Congress  43, 127, 218–​19, 275 trades unions  255, 264, 473, 546 and pensions policy  220–​1 training staff in the NHS  200, 228, 311 Trevor-​Roper, Hugh  512–​13 Tribune  282, 471, 474 troops, education of  127 Twining, Lord  312, 313 ‘two nations’  210–​13, 413 Two Nations in Old Age  217

U Uganda  307 unemployment  58, 127, 165, 180, 441 in the 1930s  34, 55, 63, 146 and automation  414 and Lloyd George  36 and Titmuss, Kay  28–​9, 53 Unemployment Assistance Board  94

Unilateral Declaration of Independence  471 United Nations  133, 173, 325 European Welfare Programme  221 Security Council  471 Social Services Section  320–​1 United States  see America universalism and selectivity  344, 417, 460–​2, 463, 549 universal services  92, 102, 194 universities  279, 324, 518, 550 ‘University and Welfare Objectives’  323 University College Hospital (UCH) London  59, 144 University College of Rhodesia  507 University of Aberdeen  148 University of Berkeley  406–​7 University of Birmingham  370 University of California  372, 406, 410, 426, 508 University of Cambridge  309 University of Chicago  427, 489, 494 University of Colorada  389 University of Columbia  231, 373–​4, 380–​3, 418, 425 University of Edinburgh  313 University of Essex  363, 458, 512, 516 University of Exeter  494 University of Glasgow  232, 333 University of Illinois  390 University of Jerusalem  151 University of Kent  505 University of London  157 University of Manchester  496 University of Michigan  375, 427, 433 University of North Carolina  370 University of Nottingham  155 University of Oxford  144, 280, 298, 425 University of Pittsburgh  395 University of Toronto  100, 374, 426, 511 University of Utah  275 University of Virginia  391 University of Washington  410 University of Wisconsin  370, 394, 405 unmarried mothers  355, 360 unmarried women  454 Unser Kampf (Our Struggle)  43 unskilled workers  409 Urwick, E.J  176 Usher Institute, Edinburgh  149

V Vaizey, John  201–​2, 263, 352, 543, 551, 555 values, shared  7, 94

583

RICHARD TITMUSS Veit-​Wilson, John  356 Vera Moberly Lectureship  375 Veysey, Victor  432 Victor Gollancz  125, 131 Vietnam War  403, 468–​70, 508–​9 Vivian, Angela  350, 496 voluntarism  7, 8, 483, 529 voluntary hospitals  99 voluntary organisations  92, 96, 267–​8, 302, 336 and one-​parent families  355 in Tanganyika  311 WVS  98

W Waddilove, Lewis  492, 493 Wakeford, R.L  127, 128 Wall Street Journal  432 Walsha, Robert  257 war, fear of  37, 38, 47 ‘War and Society’  101 Warburg, Freddy  100 war history, official  52, 167 ‘War on Poverty’  280, 370, 391, 404, 410, 413 Washington Post, The  236 Waste of Life  55 Watkinson, Harold  211 WEA  see Workers’ Educational Association wealth  see affluence Wealth of Nations  213 Webb, Sidney and Beatrice  137–​8, 176 Webster, Charles  161, 192, 198 Wedderburn, Dorothy  10, 277 Weitzman, David  156 Welcome Institute  490 welfare  180, 251–​68, 541–​2, 546, 553 American  387, 403, 423 Commitment to Welfare  349–​65 philosophy of  173, 436, 551 ‘Welfare Professor’  221, 255 welfare state  1–​3, 94 direction of  161 Essays on ‘The Welfare State’  251–​5 Israel  317 Welshman, John  291, 293, 361 West, Sarah  493, 494 Western Mail  479 Westfield, O.W  392 West Germany  362–​3, 478 Westley, William  426 Westminster Hospital  528 Whitehorn, Katharine  456–​7 Who Believes Socialism is Old-​Fashioned? The Titmuss Bombshell  282 Wickenden, Elizabeth  424, 432

wildcat strikes  264 Wildmann, Leo  362 Wilensky, H.L  229 Wilkie, James  232 Williams, Dr Arthur  311 Williams, Shirley  8, 260, 468, 518, 525, 532 Willink Committee on Medical Manpower  294, 300, 410 ‘Will the War on Poverty Change America’  425 Wilmott, Phyllis  526 Wilson, Harold  4, 13, 130, 267, 468, 544 Kenyan Asians  474–​5 medical education  294 pensions policy  216–​17 Rhodesia  471 Winner, Albertine  122, 190, 292, 295 Winnicott, Clare  231, 234 Winston, Ellen  418 Witte, Edwin  370–​1 women  23, 59, 98, 131, 339, 416 and cohabitation  454–​6, 458 and employment  29, 150, 151, 175, 231 position of  10, 141, 143, 173–​6, 185, 545 single mothers  354–​6, 363–​5 students  158–​9, 231, 295 see also Women’s Voluntary Services Women’s Voluntary Services  97–​8, 99, 529 Wood, Christopher  311 Woodcock, George  275 Wootton, Barbara  157, 174, 253, 255, 266, 370 worker, degradation of the  183 Workers’ Educational Association  266, 267, 274, 477–​8 workforce, deskilling the  164 working class  92, 98, 178, 255, 256, 324 and birth control  138 and education  120, 201 women  79–​80, 174, 184 World Health Organization  398 Wrigley, Sir John  87, 159 WVS  see Women’s Voluntary Services Wyman, George  383

Y Yale University  312, 373–​80, 391, 424 York, poverty in  55 Young, Ernest  35 Young, Michael  178, 190, 310, 423, 530

584

Index Young, Professor James  121 Younghusband, Eileen  176, 229, 231–​40, 241–​6 Case for Family Allowances  79 Younghusband Report  290 young offenders  332, 336

Z Zander, Michael  448 Zuckerman, Solly  98 Zweig, Ferdynand  176

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“Richard Titmuss had a profound influence on social and welfare policy. This authoritative biography demonstrates his past impact, but also how his ideas can continue to contribute to policy debates today.”

Virginia Berridge, London School of Hygiene and Tropical Medicine

“More than a life story, Stewart’s lucid and intelligent study sets the evolution of Titmuss’s thought against the politics of the emergent welfare state. A must-read for scholars of British social policy.”

Martin Gorsky, London School of Hygiene and Tropical Medicine

“A full and engaging analysis, with much relevance to today, of how the pioneer of social policy worked in many fields to establish it as a broad-based subject.”

This is the first fulllength biography of Richard Titmuss, a pioneer of social policy research and an influential figure in Britain’s post-war welfare debates. Drawing on his own papers, publications, and interviews with those who knew him, the book discusses Titmuss’s ideas, particularly those around the principles of altruism and social solidarity, as well as his role in policy and academic networks at home and overseas. It is an enlightening portrait of a man who deepened our understanding of social problems as well as the policies that respond most effectively to them.

Adrian Sinfield, The University of Edinburgh

LSE Pioneers in Social Policy Brian Abel-Smith, Richard Titmuss and Peter Townsend, all based at the London School of Economics and Political Science, made major contributions to the development of policies on the elderly, health care, law, poverty and welfare in the 20th century. This series of biographies tells the stories of these outstanding individuals: their backgrounds, ideas and work.

ISBN 978-1-4473-4105-5

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